- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.54 / $9,175.68 / $29,816.64
| Facility | | $1,065.54 | $9,175.68 | $29,816.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $10,288.00 / $26,304.00
| Facility | | $2,310.00 | $10,288.00 | $26,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.63 / $1,126.19 / $1,299.45
| Facility | | $883.63 | $1,126.19 | $1,299.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,909.74 / $3,909.74 / $3,909.74
| Facility | | $3,909.74 | $3,909.74 | $3,909.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,699.00 / $10,000.00 / $15,750.00
| Facility | | $4,699.00 | $10,000.00 | $15,750.00 |