- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.42 / $8,037.00 / $11,754.00
| Facility | | $1,100.42 | $8,037.00 | $11,754.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.00 / $3,232.00 / $8,800.00
| Facility | | $1,304.00 | $3,232.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.40 / $892.08 / $1,393.88
| Facility | | $743.40 | $892.08 | $1,393.88 |
- 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 |