- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.85 / $4,305.00 / $8,031.00
| Facility | | $1,448.85 | $4,305.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,678.00 / $13,347.00 / $25,477.00
| Facility | | $10,678.00 | $13,347.00 | $25,477.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $843.00 / $843.00
| Facility | | $843.00 | $843.00 | $843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $1,677.00 / $5,292.53
| Facility | | $1,643.00 | $1,677.00 | $5,292.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $3,075.00 / $6,664.00
| Facility | | $1,380.00 | $3,075.00 | $6,664.00 |