- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.85 / $4,723.00 / $11,627.00
| Facility | | $1,127.85 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $8,450.20 / $15,206.26
| Facility | | $3,315.00 | $8,450.20 | $15,206.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.20 / $1,280.64 / $2,001.00
| Facility | | $1,067.20 | $1,280.64 | $2,001.00 |
- 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 |