- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,048.37 / $7,625.00 / $11,735.00
| Facility | | $2,048.37 | $7,625.00 | $11,735.00 |
- 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
- $1,394.55 / $1,673.46 / $2,614.79
| Facility | | $1,394.55 | $1,673.46 | $2,614.79 |
- 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 |