- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $6,251.00 / $11,581.00
| Facility | | $1,375.00 | $6,251.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,426.00 / $12,098.50 / $21,233.00
| Facility | | $4,426.00 | $12,098.50 | $21,233.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.43 / $1,102.11 / $1,364.10
| Facility | | $918.43 | $1,102.11 | $1,364.10 |
- 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 |