- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,903.49 / $6,404.00 / $11,627.00
| Facility | | $1,903.49 | $6,404.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,426.00 / $19,117.00
| Facility | | $2,084.00 | $4,426.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,654.40 / $1,654.40 / $2,409.05
| Facility | | $1,654.40 | $1,654.40 | $2,409.05 |
- 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 |