- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,502.70 / $5,355.00 / $10,817.74
| Facility | | $1,502.70 | $5,355.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,470.00 / $16,493.91 / $30,520.67
| Facility | | $4,470.00 | $16,493.91 | $30,520.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.57 / $1,296.68 / $2,026.07
| Facility | | $1,080.57 | $1,296.68 | $2,026.07 |
- 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
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |