- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.78 / $3,602.00 / $10,635.00
| Facility | | $1,039.78 | $3,602.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $8,173.00 / $36,529.00
| Facility | | $2,097.00 | $8,173.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.57 / $892.72 / $1,185.65
| Facility | | $695.57 | $892.72 | $1,185.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.06 / $882.06 / $882.06
| Facility | | $882.06 | $882.06 | $882.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,534.00 / $9,390.00 / $12,871.00
| Facility | | $4,534.00 | $9,390.00 | $12,871.00 |