- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.02 / $7,155.00 / $12,096.23
| Facility | | $1,197.02 | $7,155.00 | $12,096.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.00 / $4,932.00 / $25,522.00
| Facility | | $2,291.00 | $4,932.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,143.72 / $1,372.46 / $1,698.73
| Facility | | $1,143.72 | $1,372.46 | $1,698.73 |
- 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 |