- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.61 / $5,217.00 / $11,627.00
| Facility | | $1,247.61 | $5,217.00 | $11,627.00 |
- 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
- $1,120.24 / $1,631.22 / $1,631.22
| Facility | | $1,120.24 | $1,631.22 | $1,631.22 |
- 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
- $2,840.00 / $5,513.00 / $7,847.00
| Facility | | $2,840.00 | $5,513.00 | $7,847.00 |