- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.52 / $3,650.85 / $10,635.00
| Facility | | $1,360.52 | $3,650.85 | $10,635.00 |
- 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
- $947.82 / $1,033.98 / $1,505.62
| Facility | | $947.82 | $1,033.98 | $1,505.62 |
- 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
- $1,219.94 / $1,219.94 / $1,219.94
| Facility | | $1,219.94 | $1,219.94 | $1,219.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |