- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.84 / $1,901.78 / $10,561.00
| Facility | | $1,199.84 | $1,901.78 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,510.35 / $4,510.35 / $4,576.17
| Facility | | $4,510.35 | $4,510.35 | $4,576.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $24,189.88
| Facility | | $748.70 | $748.70 | $24,189.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.84 / $1,682.00 / $2,688.16
| Facility | | $1,199.84 | $1,682.00 | $2,688.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,537.08 / $69,777.17 / $79,943.20
| Facility | | $4,537.08 | $69,777.17 | $79,943.20 |