- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $3,008.00 / $6,483.00
| Facility | | $1,582.00 | $3,008.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,640.88 / $2,700.74
| Facility | | $438.60 | $1,640.88 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,625.25 / $19,625.25 / $19,625.25
| Facility | | $19,625.25 | $19,625.25 | $19,625.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.28 / $501.62 / $6,117.00
| Facility | | $381.28 | $501.62 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $4,545.00 / $7,217.00
| Facility | | $2,912.00 | $4,545.00 | $7,217.00 |