- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,347.22 / $4,723.00 / $11,627.00
| Facility | | $1,347.22 | $4,723.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,638.88 / $7,944.89 / $15,216.00
| Facility | | $3,638.88 | $7,944.89 | $15,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.82 / $1,707.78 / $2,155.92
| Facility | | $1,172.82 | $1,707.78 | $2,155.92 |
- 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
- $1,771.00 / $3,098.00 / $6,792.00
| Facility | | $1,771.00 | $3,098.00 | $6,792.00 |