- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,232.61 / $4,934.00 / $11,581.00
| Facility | | $1,232.61 | $4,934.00 | $11,581.00 |
- 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
- $818.76 / $818.76 / $1,192.21
| Facility | | $818.76 | $818.76 | $1,192.21 |
- 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 |