- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,617.80 / $8,023.57 / $9,250.70
| Facility | | $6,617.80 | $8,023.57 | $9,250.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,433.84 / $27,433.84 / $27,433.84
| Facility | | $27,433.84 | $27,433.84 | $27,433.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,067.00 / $4,334.00
| Facility | | $1,252.00 | $3,067.00 | $4,334.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,887.00 / $9,370.48 / $16,082.68
| Facility | | $5,887.00 | $9,370.48 | $16,082.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $5,310.00 / $14,197.82
| Facility | | $2,156.00 | $5,310.00 | $14,197.82 |