- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,399.04 / $6,582.00 / $11,581.00
| Facility | | $1,399.04 | $6,582.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.00 / $12,094.63 / $21,233.00
| Facility | | $4,142.00 | $12,094.63 | $21,233.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.10 / $1,096.92 / $1,357.67
| Facility | | $914.10 | $1,096.92 | $1,357.67 |
- 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
- $2,466.00 / $4,021.00 / $6,831.00
| Facility | | $2,466.00 | $4,021.00 | $6,831.00 |