- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,595.19 / $6,251.00 / $11,581.00
| Facility | | $1,595.19 | $6,251.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,392.00 / $13,240.08 / $22,636.66
| Facility | | $3,392.00 | $13,240.08 | $22,636.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.12 / $1,357.30 / $1,713.47
| Facility | | $932.12 | $1,357.30 | $1,713.47 |
- 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
- $4,070.00 / $8,448.00 / $13,382.00
| Facility | | $4,070.00 | $8,448.00 | $13,382.00 |