- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,071.96 / $8,055.00 / $12,117.00
| Facility | | $2,071.96 | $8,055.00 | $12,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.00 / $12,455.21 / $21,287.94
| Facility | | $4,142.00 | $12,455.21 | $21,287.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.31 / $1,541.17 / $1,907.53
| Facility | | $1,284.31 | $1,541.17 | $1,907.53 |
- 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 |