- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.78 / $7,501.00 / $12,672.00
| Facility | | $2,376.78 | $7,501.00 | $12,672.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,932.00 / $41,639.47 / $76,926.81
| Facility | | $6,932.00 | $41,639.47 | $76,926.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,157.89 / $2,354.06 / $3,427.84
| Facility | | $2,157.89 | $2,354.06 | $3,427.84 |
- 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
- $2,767.50 / $2,767.50 / $2,767.50
| Facility | | $2,767.50 | $2,767.50 | $2,767.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.00 / $10,529.00 / $15,469.00
| Facility | | $4,873.00 | $10,529.00 | $15,469.00 |