- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.18 / $11,671.80 / $23,025.80
| Facility | | $1,433.18 | $11,671.80 | $23,025.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $10,862.64 / $18,562.29
| Facility | | $5,000.00 | $10,862.64 | $18,562.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,229.55 / $6,229.55 / $8,005.08
| Facility | | $6,229.55 | $6,229.55 | $8,005.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,022.50 / $1,449.72 / $2,371.78
| Facility | | $1,022.50 | $1,449.72 | $2,371.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,766.00 / $19,526.00 / $24,161.00
| Facility | | $8,766.00 | $19,526.00 | $24,161.00 |