- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $5,551.00 / $16,900.00
| Facility | | $1,456.00 | $5,551.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,426.66 / $29,273.44 / $46,251.71
| Facility | | $18,426.66 | $29,273.44 | $46,251.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,580.67 / $23,580.67 / $23,580.67
| Facility | | $23,580.67 | $23,580.67 | $23,580.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.22 / $1,707.55 / $20,190.00
| Facility | | $1,229.22 | $1,707.55 | $20,190.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,228.00 / $10,642.00 / $20,423.23
| Facility | | $3,228.00 | $10,642.00 | $20,423.23 |