- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.00 / $5,201.00 / $11,627.00
| Facility | | $1,165.00 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,437.00 / $19,117.00
| Facility | | $2,084.00 | $4,437.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.39 / $770.39 / $1,121.78
| Facility | | $770.39 | $770.39 | $1,121.78 |
- 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 / $8,448.00 / $13,382.00
| Facility | | $4,070.00 | $8,448.00 | $13,382.00 |