- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,374.83 / $16,724.90 / $25,496.20
| Facility | | $8,374.83 | $16,724.90 | $25,496.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $1,500.00 / $1,796.00
| Facility | | $1,500.00 | $1,500.00 | $1,796.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,220.76 / $16,198.36 / $28,819.45
| Facility | | $10,220.76 | $16,198.36 | $28,819.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $10,455.84 / $28,577.88
| Facility | | $900.00 | $10,455.84 | $28,577.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $6,504.12 / $28,577.88
| Facility | | $600.00 | $6,504.12 | $28,577.88 |