- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,306.00 / $6,944.00 / $11,581.00
| Facility | | $2,306.00 | $6,944.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $13,964.62 / $26,394.04
| Facility | | $5,577.00 | $13,964.62 | $26,394.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,744.20 / $2,539.79 / $3,206.25
| Facility | | $1,744.20 | $2,539.79 | $3,206.25 |
- 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 / $6,792.00
| Facility | | $1,480.00 | $3,086.00 | $6,792.00 |