- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.80 / $5,217.00 / $11,627.00
| Facility | | $1,412.80 | $5,217.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.00 / $3,974.00 / $19,117.00
| Facility | | $2,009.00 | $3,974.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.09 / $1,218.10 / $1,507.67
| Facility | | $1,015.09 | $1,218.10 | $1,507.67 |
- 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 / $4,383.00 / $6,522.00
| Facility | | $2,233.00 | $4,383.00 | $6,522.00 |