- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.14 / $5,396.00 / $11,627.00
| Facility | | $1,511.14 | $5,396.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,541.00 / $15,092.00
| Facility | | $1,760.00 | $3,541.00 | $15,092.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.95 / $1,316.95 / $1,917.66
| Facility | | $1,316.95 | $1,316.95 | $1,917.66 |
- 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
- $3,793.00 / $6,392.00 / $10,023.00
| Facility | | $3,793.00 | $6,392.00 | $10,023.00 |