- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,440.31 / $7,639.00 / $11,627.00
| Facility | | $1,440.31 | $7,639.00 | $11,627.00 |
- 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
- $1,280.15 / $1,536.18 / $1,901.36
| Facility | | $1,280.15 | $1,536.18 | $1,901.36 |
- 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
- $1,771.00 / $3,098.00 / $6,792.00
| Facility | | $1,771.00 | $3,098.00 | $6,792.00 |