- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,501.83 / $8,422.00 / $12,615.00
| Facility | | $1,501.83 | $8,422.00 | $12,615.00 |
- 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
- $858.38 / $1,030.06 / $1,609.47
| Facility | | $858.38 | $1,030.06 | $1,609.47 |
- 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
- $3,793.00 / $6,579.00 / $10,989.00
| Facility | | $3,793.00 | $6,579.00 | $10,989.00 |