- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,789.68 / $6,919.00 / $11,581.00
| Facility | | $1,789.68 | $6,919.00 | $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
- $1,550.63 / $1,860.76 / $2,471.31
| Facility | | $1,550.63 | $1,860.76 | $2,471.31 |
- 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 |