- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.81 / $5,135.00 / $10,817.74
| Facility | | $1,175.81 | $5,135.00 | $10,817.74 |
- 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
- $874.41 / $1,049.29 / $1,639.52
| Facility | | $874.41 | $1,049.29 | $1,639.52 |
- 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 |