- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.12 / $6,251.00 / $11,581.00
| Facility | | $1,371.12 | $6,251.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.00 / $4,142.00 / $19,117.00
| Facility | | $2,003.00 | $4,142.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.43 / $1,051.72 / $1,301.72
| Facility | | $876.43 | $1,051.72 | $1,301.72 |
- 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
- $2,466.00 / $4,404.00 / $6,831.00
| Facility | | $2,466.00 | $4,404.00 | $6,831.00 |