- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.14 / $6,582.00 / $11,581.00
| Facility | | $1,357.14 | $6,582.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.00 / $4,616.00 / $25,522.00
| Facility | | $2,291.00 | $4,616.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.30 / $1,039.56 / $1,624.32
| Facility | | $866.30 | $1,039.56 | $1,624.32 |
- 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
- $3,206.00 / $6,578.00 / $10,075.00
| Facility | | $3,206.00 | $6,578.00 | $10,075.00 |