- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,645.00 / $9,121.00 / $18,477.50
| Facility | | $1,645.00 | $9,121.00 | $18,477.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,523.00 / $12,442.55 / $28,629.56
| Facility | | $9,523.00 | $12,442.55 | $28,629.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.00 / $13,322.40 / $20,742.06
| Facility | | $6,916.00 | $13,322.40 | $20,742.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,134.89 / $20,859.59 / $31,972.62
| Facility | | $13,134.89 | $20,859.59 | $31,972.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $17,223.00 / $29,651.00
| Facility | | $5,700.00 | $17,223.00 | $29,651.00 |