- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.55 / $5,135.00 / $11,627.00
| Facility | | $1,130.55 | $5,135.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.00 / $7,949.51 / $14,996.00
| Facility | | $3,405.00 | $7,949.51 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.91 / $1,441.14 / $1,783.72
| Facility | | $1,191.91 | $1,441.14 | $1,783.72 |
- 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 |