- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.67 / $6,653.00 / $9,637.10
| Facility | | $1,010.67 | $6,653.00 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,154.00 / $10,509.00 / $16,131.00
| Facility | | $8,154.00 | $10,509.00 | $16,131.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.00 / $9,619.46 / $9,619.46
| Facility | | $843.00 | $9,619.46 | $9,619.46 |
- 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 |