- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.00 / $12,411.48 / $16,857.34
| Facility | | $1,173.00 | $12,411.48 | $16,857.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $24,214.00 / $45,778.00
| Facility | | $2,575.00 | $24,214.00 | $45,778.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.69 / $1,529.91 / $2,294.87
| Facility | | $1,083.69 | $1,529.91 | $2,294.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,405.61 / $6,405.61 / $6,405.61
| Facility | | $6,405.61 | $6,405.61 | $6,405.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,699.00 / $9,550.00 / $15,750.00
| Facility | | $4,699.00 | $9,550.00 | $15,750.00 |