- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,914.00 / $5,124.25 / $12,856.00
| Facility | | $1,914.00 | $5,124.25 | $12,856.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,216.00 / $10,498.00 / $16,629.00
| Facility | | $5,216.00 | $10,498.00 | $16,629.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,413.00 / $12,909.00 / $22,801.00
| Facility | | $9,413.00 | $12,909.00 | $22,801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,548.12 / $51,247.45 / $51,247.45
| Facility | | $10,548.12 | $51,247.45 | $51,247.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,827.00 / $14,882.00 / $33,761.00
| Facility | | $6,827.00 | $14,882.00 | $33,761.00 |