- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,677.35 / $12,882.50
| Facility | | $1,202.26 | $4,677.35 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,943.28 / $15,135.61
| Facility | | $4,570.88 | $7,943.28 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $7,943.28 / $7,943.28
| Facility | | $776.25 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $10,000.00 / $10,000.00
| Facility | | $4,073.80 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $50,118.72 / $50,118.72
| Facility | | $16,218.10 | $50,118.72 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,584.89 / $8,128.31
| Facility | | $851.14 | $1,584.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $1,995.26
| Facility | | $794.33 | $1,148.15 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $8,317.64 / $17,378.01
| Facility | | $2,630.27 | $8,317.64 | $17,378.01 |