- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.68 / $6,163.00 / $11,627.00
| Facility | | $1,376.68 | $6,163.00 | $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
- $1,315.71 / $1,578.85 / $1,954.17
| Facility | | $1,315.71 | $1,578.85 | $1,954.17 |
- 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 |