- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.45 / $5,135.00 / $10,817.74
| Facility | | $1,087.45 | $5,135.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,437.00 / $19,117.00
| Facility | | $2,084.00 | $4,437.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.41 / $829.54 / $1,207.92
| Facility | | $760.41 | $829.54 | $1,207.92 |
- 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
- $972.50 / $972.50 / $972.50
| Facility | | $972.50 | $972.50 | $972.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |