- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.82 / $5,075.00 / $16,732.00
| Facility | | $1,283.82 | $5,075.00 | $16,732.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,023.00 / $24,040.00 / $31,898.00
| Facility | | $16,023.00 | $24,040.00 | $31,898.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.82 / $1,617.55 / $3,030.53
| Facility | | $1,283.82 | $1,617.55 | $3,030.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,492.00 / $13,856.00 / $19,832.00
| Facility | | $6,492.00 | $13,856.00 | $19,832.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,281.07 / $13,281.07 / $16,098.28
| Facility | | $13,281.07 | $13,281.07 | $16,098.28 |