- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.15 / $6,571.00 / $10,492.00
| Facility | | $1,191.15 | $6,571.00 | $10,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,407.00 / $15,521.00 / $29,890.00
| Facility | | $8,407.00 | $15,521.00 | $29,890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.00 / $13,102.83 / $13,102.83
| Facility | | $1,041.00 | $13,102.83 | $13,102.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,363.21 / $6,595.00 / $6,730.00
| Facility | | $5,363.21 | $6,595.00 | $6,730.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,565.00 / $6,647.00 / $9,973.00
| Facility | | $4,565.00 | $6,647.00 | $9,973.00 |