- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,868.00 / $23,020.10 / $31,845.50
| Facility | | $6,868.00 | $23,020.10 | $31,845.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $17,821.38
| Facility | | $1,146.00 | $3,000.00 | $17,821.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,664.44 / $11,971.61 / $22,205.62
| Facility | | $8,664.44 | $11,971.61 | $22,205.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,664.44 / $12,362.40 / $22,205.62
| Facility | | $8,664.44 | $12,362.40 | $22,205.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.00 / $15,322.51 / $23,757.79
| Facility | | $5,419.00 | $15,322.51 | $23,757.79 |