- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.73 / $6,813.00 / $14,500.00
| Facility | | $1,414.73 | $6,813.00 | $14,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.00 / $3,974.00 / $19,117.00
| Facility | | $2,009.00 | $3,974.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.36 / $1,207.65 / $1,524.54
| Facility | | $829.36 | $1,207.65 | $1,524.54 |
- 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
- $4,070.00 / $8,796.00 / $13,009.00
| Facility | | $4,070.00 | $8,796.00 | $13,009.00 |