- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.10 / $4,956.00 / $11,627.00
| Facility | | $1,450.10 | $4,956.00 | $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
- $1,261.92 / $1,837.53 / $2,319.71
| Facility | | $1,261.92 | $1,837.53 | $2,319.71 |
- 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 |