- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.72 / $5,907.00 / $10,635.00
| Facility | | $1,128.72 | $5,907.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,576.00 / $14,996.00
| Facility | | $1,760.00 | $3,576.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.72 / $1,224.20 / $1,224.20
| Facility | | $840.72 | $1,224.20 | $1,224.20 |
- 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 / $4,138.00 / $6,522.00
| Facility | | $2,233.00 | $4,138.00 | $6,522.00 |