- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.97 / $8,553.00 / $11,627.00
| Facility | | $1,065.97 | $8,553.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.00 / $3,974.00 / $19,117.00
| Facility | | $2,009.00 | $3,974.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.68 / $1,349.37 / $1,703.46
| Facility | | $926.68 | $1,349.37 | $1,703.46 |
- 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
- $4,070.00 / $8,796.00 / $13,009.00
| Facility | | $4,070.00 | $8,796.00 | $13,009.00 |