- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.07 / $6,508.00 / $9,637.10
| Facility | | $2,691.07 | $6,508.00 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,743.00 / $14,186.00 / $16,825.66
| Facility | | $7,743.00 | $14,186.00 | $16,825.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $12,593.23 / $12,593.23
| Facility | | $843.00 | $12,593.23 | $12,593.23 |
- 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
- $5,366.05 / $5,366.05 / $5,366.05
| Facility | | $5,366.05 | $5,366.05 | $5,366.05 |
- 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 |