- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.36 / $6,391.00 / $11,627.00
| Facility | | $1,395.36 | $6,391.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,794.51 / $17,502.61 / $31,141.30
| Facility | | $6,794.51 | $17,502.61 | $31,141.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,398.17 / $1,525.27 / $2,221.00
| Facility | | $1,398.17 | $1,525.27 | $2,221.00 |
- 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
- $1,766.56 / $1,766.56 / $1,766.56
| Facility | | $1,766.56 | $1,766.56 | $1,766.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.00 / $10,529.00 / $15,469.00
| Facility | | $4,873.00 | $10,529.00 | $15,469.00 |