- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,176.67 / $6,805.10 / $9,637.10
| Facility | | $2,176.67 | $6,805.10 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,282.00 / $15,501.00 / $24,801.00
| Facility | | $6,282.00 | $15,501.00 | $24,801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $23,252.19 / $23,252.19
| Facility | | $843.00 | $23,252.19 | $23,252.19 |
- 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 / $17,777.00
| Facility | | $6,943.00 | $10,336.00 | $17,777.00 |