- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.00 / $2,077.00 / $42,689.60
| Facility | | $1,164.00 | $2,077.00 | $42,689.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,544.00 / $3,192.00 / $17,653.84
| Facility | | $2,544.00 | $3,192.00 | $17,653.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,265.37 / $6,300.36 / $10,595.11
| Facility | | $3,265.37 | $6,300.36 | $10,595.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,642.40 / $47,002.60 / $73,867.87
| Facility | | $26,642.40 | $47,002.60 | $73,867.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.00 / $5,178.00 / $69,060.09
| Facility | | $1,308.00 | $5,178.00 | $69,060.09 |