- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.55 / $3,442.34 / $10,268.00
| Facility | | $1,266.55 | $3,442.34 | $10,268.00 |
- 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
- $810.83 / $973.00 / $1,204.29
| Facility | | $810.83 | $973.00 | $1,204.29 |
- 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
- $3,206.00 / $6,578.00 / $10,075.00
| Facility | | $3,206.00 | $6,578.00 | $10,075.00 |