- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,575.12 / $6,582.00 / $11,627.00
| Facility | | $1,575.12 | $6,582.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.00 / $4,932.00 / $25,522.00
| Facility | | $2,291.00 | $4,932.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,505.39 / $1,806.47 / $2,235.90
| Facility | | $1,505.39 | $1,806.47 | $2,235.90 |
- 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 |