- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.21 / $25,305.74 / $41,465.28
| Facility | | $1,042.21 | $25,305.74 | $41,465.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.91 / $1,076.02 / $1,172.33
| Facility | | $948.91 | $1,076.02 | $1,172.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.80 / $1,018.80 / $1,018.80
| Facility | | $1,018.80 | $1,018.80 | $1,018.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,543.17 / $46,395.65 / $155,780.14
| Facility | | $13,543.17 | $46,395.65 | $155,780.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,446.00 / $34,446.00 / $34,446.00
| Facility | | $34,446.00 | $34,446.00 | $34,446.00 |