- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,780.56 / $7,155.00 / $11,581.00
| Facility | | $1,780.56 | $7,155.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,724.00 / $14,299.15 / $25,723.30
| Facility | | $4,724.00 | $14,299.15 | $25,723.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.38 / $1,363.66 / $2,130.71
| Facility | | $1,136.38 | $1,363.66 | $2,130.71 |
- 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 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |