- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,645.00 / $9,121.00 / $28,750.80
| Facility | | $1,645.00 | $9,121.00 | $28,750.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,523.00 / $14,876.62 / $21,817.04
| Facility | | $9,523.00 | $14,876.62 | $21,817.04 |
- 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
- $14,313.00 / $32,350.32 / $49,748.92
| Facility | | $14,313.00 | $32,350.32 | $49,748.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $17,223.00 / $44,604.13
| Facility | | $5,700.00 | $17,223.00 | $44,604.13 |