- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,097.03 / $8,553.00 / $11,627.00
| Facility | | $1,097.03 | $8,553.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.00 / $15,620.02 / $26,817.40
| Facility | | $4,142.00 | $15,620.02 | $26,817.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.78 / $1,751.42 / $1,751.42
| Facility | | $1,202.78 | $1,751.42 | $1,751.42 |
- 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 / $2,934.00 / $6,111.00
| Facility | | $1,480.00 | $2,934.00 | $6,111.00 |