- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,045.73 / $6,582.00 / $11,627.00
| Facility | | $1,045.73 | $6,582.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.00 / $14,489.11 / $24,772.14
| Facility | | $4,142.00 | $14,489.11 | $24,772.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.29 / $1,277.15 / $1,580.75
| Facility | | $1,064.29 | $1,277.15 | $1,580.75 |
- 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 |