- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.43 / $8,553.00 / $11,627.00
| Facility | | $1,147.43 | $8,553.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,566.00 / $54,977.04 / $93,994.63
| Facility | | $8,566.00 | $54,977.04 | $93,994.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.86 / $1,002.86 / $1,460.30
| Facility | | $1,002.86 | $1,002.86 | $1,460.30 |
- 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 / $6,792.00
| Facility | | $1,480.00 | $3,086.00 | $6,792.00 |