- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,862.00 / $7,088.65 / $9,637.10
| Facility | | $2,862.00 | $7,088.65 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,905.00 / $22,514.00 / $29,306.22
| Facility | | $12,905.00 | $22,514.00 | $29,306.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $24,685.43 / $24,685.43
| Facility | | $843.00 | $24,685.43 | $24,685.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,363.21 / $6,595.00 / $6,730.00
| Facility | | $5,363.21 | $6,595.00 | $6,730.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,943.00 / $10,336.00 / $17,069.00
| Facility | | $6,943.00 | $10,336.00 | $17,069.00 |