- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $8,662.42 / $11,627.00
| Facility | | $2,454.71 | $8,662.42 | $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
- $2,484.94 / $2,981.94 / $4,659.29
| Facility | | $2,484.94 | $2,981.94 | $4,659.29 |
- 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 |