- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,078.00 / $5,907.00 / $11,581.00
| Facility | | $2,078.00 | $5,907.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,392.00 / $9,381.99 / $16,655.00
| Facility | | $3,392.00 | $9,381.99 | $16,655.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,167.44 / $3,156.10 / $3,156.10
| Facility | | $2,167.44 | $3,156.10 | $3,156.10 |
- 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
- $2,233.00 / $4,138.00 / $6,522.00
| Facility | | $2,233.00 | $4,138.00 | $6,522.00 |