- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.96 / $8,050.00 / $11,627.00
| Facility | | $1,161.96 | $8,050.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,426.00 / $12,098.50 / $21,233.00
| Facility | | $4,426.00 | $12,098.50 | $21,233.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.16 / $912.19 / $1,129.03
| Facility | | $760.16 | $912.19 | $1,129.03 |
- 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
- $2,749.50 / $5,625.00 / $7,821.00
| Facility | | $2,749.50 | $5,625.00 | $7,821.00 |