- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.95 / $2,150.13 / $27,282.96
| Facility | | $1,346.95 | $2,150.13 | $27,282.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.95 / $1,691.79 / $2,731.01
| Facility | | $1,346.95 | $1,691.79 | $2,731.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,956.40 / $10,956.40
| Facility | | $55.00 | $10,956.40 | $10,956.40 |