- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.19 / $1,615.00 / $7,439.00
| Facility | | $1,411.19 | $1,615.00 | $7,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $13,652.00
| Facility | | $606.10 | $606.10 | $13,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.06 / $1,820.62 / $2,918.13
| Facility | | $1,474.06 | $1,820.62 | $2,918.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,153.00 / $21,463.00 / $29,047.00
| Facility | | $8,153.00 | $21,463.00 | $29,047.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $15,766.02 / $15,766.02
| Facility | | $5,000.00 | $15,766.02 | $15,766.02 |