- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,873.58 / $8,553.00 / $79,101.20
| Facility | | $1,873.58 | $8,553.00 | $79,101.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,638.88 / $7,944.89 / $15,216.00
| Facility | | $3,638.88 | $7,944.89 | $15,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,627.55 / $1,627.55 / $2,369.94
| Facility | | $1,627.55 | $1,627.55 | $2,369.94 |
- 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
- $1,480.00 / $3,086.00 / $6,792.00
| Facility | | $1,480.00 | $3,086.00 | $6,792.00 |