- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.34 / $8,037.00 / $11,754.00
| Facility | | $1,745.34 | $8,037.00 | $11,754.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,437.00 / $19,117.00
| Facility | | $2,084.00 | $4,437.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.75 / $1,552.50 / $2,425.79
| Facility | | $1,293.75 | $1,552.50 | $2,425.79 |
- 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
- $3,206.00 / $6,578.00 / $10,075.00
| Facility | | $3,206.00 | $6,578.00 | $10,075.00 |