- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,185.00 / $15,376.20 / $27,413.10
| Facility | | $2,185.00 | $15,376.20 | $27,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,575.00 / $4,575.00 / $4,575.00
| Facility | | $4,575.00 | $4,575.00 | $4,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,421.00 / $12,862.89 / $23,761.48
| Facility | | $2,421.00 | $12,862.89 | $23,761.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,897.53 / $14,330.12 / $20,374.02
| Facility | | $12,897.53 | $14,330.12 | $20,374.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,787.00 / $17,680.84 / $45,029.69
| Facility | | $8,787.00 | $17,680.84 | $45,029.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,847.50 / $16,881.03 / $23,725.46
| Facility | | $8,847.50 | $16,881.03 | $23,725.46 |