- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,645.00 / $6,906.00 / $18,678.00
| Facility | | $1,645.00 | $6,906.00 | $18,678.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,117.00 / $11,639.16 / $28,880.94
| Facility | | $8,117.00 | $11,639.16 | $28,880.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,907.14 / $7,708.25 / $20,249.11
| Facility | | $4,907.14 | $7,708.25 | $20,249.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,364.00 / $21,085.87 / $32,319.46
| Facility | | $14,364.00 | $21,085.87 | $32,319.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,785.00 / $12,234.00 / $29,972.65
| Facility | | $4,785.00 | $12,234.00 | $29,972.65 |