- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.79 / $4,723.00 / $11,627.00
| Facility | | $1,078.79 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,408.00 / $14,299.15 / $25,723.30
| Facility | | $4,408.00 | $14,299.15 | $25,723.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.96 / $1,238.34 / $1,934.93
| Facility | | $1,031.96 | $1,238.34 | $1,934.93 |
- 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
- $4,873.00 / $10,707.00 / $15,469.00
| Facility | | $4,873.00 | $10,707.00 | $15,469.00 |