- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.49 / $5,135.00 / $11,627.00
| Facility | | $1,327.49 | $5,135.00 | $11,627.00 |
- 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
- $1,290.77 / $1,548.92 / $1,917.13
| Facility | | $1,290.77 | $1,548.92 | $1,917.13 |
- 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 |