- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,398.99 / $8,031.00 / $11,356.00
| Facility | | $1,398.99 | $8,031.00 | $11,356.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,407.00 / $24,508.27 / $45,908.09
| Facility | | $8,407.00 | $24,508.27 | $45,908.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $843.00 / $843.00
| Facility | | $843.00 | $843.00 | $843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,346.67 / $9,426.00 / $9,617.00
| Facility | | $2,346.67 | $9,426.00 | $9,617.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,943.00 / $10,336.00 / $17,777.00
| Facility | | $6,943.00 | $10,336.00 | $17,777.00 |