- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,477.27 / $19,276.96
| Facility | | $4,083.97 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,303.68 / $6,975.78 / $13,493.42
| Facility | | $5,303.68 | $6,975.78 | $13,493.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,282.31 / $22,282.31 / $22,282.31
| Facility | | $22,282.31 | $22,282.31 | $22,282.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.18 / $1,872.82 / $8,816.00
| Facility | | $1,070.18 | $1,872.82 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,951.00 / $2,861.60 / $25,110.77
| Facility | | $1,951.00 | $2,861.60 | $25,110.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |