- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,838.00 / $9,496.00 / $14,372.50
| Facility | | $3,838.00 | $9,496.00 | $14,372.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,813.00 / $17,502.61 / $31,496.21
| Facility | | $6,813.00 | $17,502.61 | $31,496.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,997.14 / $4,873.58 / $6,032.12
| Facility | | $3,997.14 | $4,873.58 | $6,032.12 |
- 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 |