- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.00 / $5,355.00 / $10,817.74
| Facility | | $1,610.00 | $5,355.00 | $10,817.74 |
- 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
- $1,269.54 / $1,523.45 / $1,885.60
| Facility | | $1,269.54 | $1,523.45 | $1,885.60 |
- 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
- $2,233.00 / $4,383.00 / $6,522.00
| Facility | | $2,233.00 | $4,383.00 | $6,522.00 |