- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.07 / $4,225.49 / $11,679.00
| Facility | | $1,164.07 | $4,225.49 | $11,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.00 / $7,949.51 / $14,996.00
| Facility | | $3,405.00 | $7,949.51 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,234.03 / $1,482.07 / $2,315.75
| Facility | | $1,234.03 | $1,482.07 | $2,315.75 |
- 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
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |