- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,835.50 / $8,553.00 / $15,040.00
| Facility | | $1,835.50 | $8,553.00 | $15,040.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,426.00 / $12,098.50 / $21,233.00
| Facility | | $4,426.00 | $12,098.50 | $21,233.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,782.79 / $2,139.35 / $2,647.91
| Facility | | $1,782.79 | $2,139.35 | $2,647.91 |
- 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
- $3,793.00 / $6,579.00 / $10,075.00
| Facility | | $3,793.00 | $6,579.00 | $10,075.00 |