- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $6,165.95 / $9,549.93
| Facility | | $1,148.15 | $6,165.95 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $21,379.62 / $57,543.99
| Facility | | $20,417.38 | $21,379.62 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $40,738.03
| Facility | | $40,738.03 | $40,738.03 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,248.07 / $9,549.93
| Facility | | $1,047.13 | $5,248.07 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $2,041.74
| Facility | | $1,288.25 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,000.00 / $1,445.44
| Facility | | $933.25 | $1,000.00 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,621.81 / $64,565.42
| Facility | | $223.87 | $1,621.81 | $64,565.42 |