- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.08 / $7,342.00 / $12,492.00
| Facility | | $1,073.08 | $7,342.00 | $12,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,528.00 / $14,996.00
| Facility | | $1,760.00 | $3,528.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.36 / $604.36 / $880.03
| Facility | | $604.36 | $604.36 | $880.03 |
- 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 / $5,920.00 / $7,847.00
| Facility | | $2,840.00 | $5,920.00 | $7,847.00 |