- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.95 / $5,355.00 / $10,817.74
| Facility | | $1,066.95 | $5,355.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $7,880.43 / $14,996.00
| Facility | | $3,315.00 | $7,880.43 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.78 / $624.78 / $909.77
| Facility | | $624.78 | $624.78 | $909.77 |
- 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 / $6,792.00
| Facility | | $1,480.00 | $3,086.00 | $6,792.00 |