- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.16 / $5,201.00 / $11,627.00
| Facility | | $1,720.16 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.00 / $14,428.74 / $24,745.60
| Facility | | $4,142.00 | $14,428.74 | $24,745.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.94 / $1,150.84 / $1,675.79
| Facility | | $1,054.94 | $1,150.84 | $1,675.79 |
- 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
- $1,355.18 / $1,355.18 / $1,355.18
| Facility | | $1,355.18 | $1,355.18 | $1,355.18 |
- 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 |