- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.20 / $5,779.00 / $11,627.00
| Facility | | $1,206.20 | $5,779.00 | $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
- $1,148.08 / $1,377.70 / $2,152.65
| Facility | | $1,148.08 | $1,377.70 | $2,152.65 |
- 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 |