- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.77 / $5,014.00 / $11,627.00
| Facility | | $1,007.77 | $5,014.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,920.00 / $15,493.10 / $29,406.00
| Facility | | $5,920.00 | $15,493.10 | $29,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.78 / $1,307.74 / $2,043.35
| Facility | | $1,089.78 | $1,307.74 | $2,043.35 |
- 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
- $1,771.00 / $3,098.00 / $6,792.00
| Facility | | $1,771.00 | $3,098.00 | $6,792.00 |