- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,253.70 / $5,355.00 / $10,817.74
| Facility | | $1,253.70 | $5,355.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.00 / $4,142.00 / $19,117.00
| Facility | | $2,009.00 | $4,142.00 | $19,117.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.90 / $1,123.08 / $1,390.06
| Facility | | $935.90 | $1,123.08 | $1,390.06 |
- 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
- $2,233.00 / $4,383.00 / $6,522.00
| Facility | | $2,233.00 | $4,383.00 | $6,522.00 |