- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,302.36 / $5,706.00 / $11,581.00
| Facility | | $1,302.36 | $5,706.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.00 / $5,480.00 / $25,522.00
| Facility | | $2,202.00 | $5,480.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.28 / $1,069.54 / $1,323.78
| Facility | | $891.28 | $1,069.54 | $1,323.78 |
- 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
- $4,227.00 / $8,796.00 / $13,382.00
| Facility | | $4,227.00 | $8,796.00 | $13,382.00 |