- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,498.62 / $5,207.00 / $11,627.00
| Facility | | $1,498.62 | $5,207.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,470.00 / $14,289.99 / $27,009.01
| Facility | | $4,470.00 | $14,289.99 | $27,009.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,434.19 / $1,721.03 / $2,130.15
| Facility | | $1,434.19 | $1,721.03 | $2,130.15 |
- 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
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |