- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,122.75 / $7,881.00 / $12,117.00
| Facility | | $2,122.75 | $7,881.00 | $12,117.00 |
- 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
- $1,449.17 / $1,739.00 / $2,717.19
| Facility | | $1,449.17 | $1,739.00 | $2,717.19 |
- 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
- $3,879.00 / $5,726.00 / $9,483.00
| Facility | | $3,879.00 | $5,726.00 | $9,483.00 |