- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,181.00 / $19,692.28 / $40,693.69
| Facility | | $5,181.00 | $19,692.28 | $40,693.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,165.00 / $32,165.00 / $32,165.00
| Facility | | $32,165.00 | $32,165.00 | $32,165.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,867.00 / $12,050.38 / $21,200.37
| Facility | | $1,867.00 | $12,050.38 | $21,200.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.52 / $20,278.34 / $45,256.85
| Facility | | $1,474.52 | $20,278.34 | $45,256.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.00 / $12,422.56 / $29,837.22
| Facility | | $428.00 | $12,422.56 | $29,837.22 |