- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.05 / $5,201.00 / $11,627.00
| Facility | | $1,103.05 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,792.00 / $8,800.00
| Facility | | $1,145.00 | $2,792.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.80 / $1,380.12 / $1,380.12
| Facility | | $947.80 | $1,380.12 | $1,380.12 |
- 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
- $1,689.00 / $2,551.00 / $5,235.00
| Facility | | $1,689.00 | $2,551.00 | $5,235.00 |