- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.56 / $6,582.00 / $11,627.00
| Facility | | $1,039.56 | $6,582.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.00 / $7,949.51 / $14,996.00
| Facility | | $3,405.00 | $7,949.51 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,104.63 / $1,325.56 / $1,640.66
| Facility | | $1,104.63 | $1,325.56 | $1,640.66 |
- 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
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |