- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.45 / $8,037.00 / $11,754.00
| Facility | | $1,030.45 | $8,037.00 | $11,754.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,392.00 / $12,090.75 / $20,671.64
| Facility | | $3,392.00 | $12,090.75 | $20,671.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.77 / $785.72 / $972.51
| Facility | | $654.77 | $785.72 | $972.51 |
- 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 |