- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.54 / $6,582.00 / $11,627.00
| Facility | | $1,109.54 | $6,582.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $8,450.20 / $15,206.26
| Facility | | $3,315.00 | $8,450.20 | $15,206.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.92 / $1,263.50 / $1,678.10
| Facility | | $1,052.92 | $1,263.50 | $1,678.10 |
- 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
- $2,233.00 / $4,383.00 / $6,522.00
| Facility | | $2,233.00 | $4,383.00 | $6,522.00 |