- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,862.00 / $6,653.00 / $9,637.10
| Facility | | $2,862.00 | $6,653.00 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,872.73 / $9,746.04 / $19,160.00
| Facility | | $7,872.73 | $9,746.04 | $19,160.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $13,336.84 / $13,336.84
| Facility | | $843.00 | $13,336.84 | $13,336.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,330.14 / $4,873.00 / $4,974.00
| Facility | | $4,330.14 | $4,873.00 | $4,974.00 |
- 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 |