- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.24 / $3,585.00 / $10,635.00
| Facility | | $1,269.24 | $3,585.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.00 / $3,555.00 / $19,117.00
| Facility | | $2,003.00 | $3,555.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.28 / $1,104.33 / $1,366.85
| Facility | | $920.28 | $1,104.33 | $1,366.85 |
- 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
- $2,904.00 / $6,111.00 / $9,245.00
| Facility | | $2,904.00 | $6,111.00 | $9,245.00 |