- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.00 / $6,805.10 / $9,637.10
| Facility | | $2,597.00 | $6,805.10 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,852.00 / $18,510.00 / $29,134.82
| Facility | | $7,852.00 | $18,510.00 | $29,134.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $12,363.32 / $12,363.32
| Facility | | $843.00 | $12,363.32 | $12,363.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,296.00 / $4,588.00 / $4,682.00
| Facility | | $3,296.00 | $4,588.00 | $4,682.00 |
- 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 |