- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.65 / $9,504.00 / $15,958.08
| Facility | | $1,388.65 | $9,504.00 | $15,958.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,724.00 / $14,299.15 / $25,723.30
| Facility | | $4,724.00 | $14,299.15 | $25,723.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.58 / $1,510.30 / $2,359.85
| Facility | | $1,258.58 | $1,510.30 | $2,359.85 |
- 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 |