- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.55 / $5,140.00 / $11,627.00
| Facility | | $1,321.55 | $5,140.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.00 / $12,455.21 / $21,287.94
| Facility | | $4,142.00 | $12,455.21 | $21,287.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,253.36 / $1,504.04 / $2,350.07
| Facility | | $1,253.36 | $1,504.04 | $2,350.07 |
- 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 |