- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.16 / $6,582.00 / $12,096.23
| Facility | | $1,178.16 | $6,582.00 | $12,096.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,638.88 / $7,944.89 / $15,216.00
| Facility | | $3,638.88 | $7,944.89 | $15,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.14 / $1,491.29 / $1,882.62
| Facility | | $1,024.14 | $1,491.29 | $1,882.62 |
- 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 |