- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,744.69 / $11,919.50 / $15,989.00
| Facility | | $5,744.69 | $11,919.50 | $15,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,833.58 / $8,833.58 / $17,569.27
| Facility | | $8,833.58 | $8,833.58 | $17,569.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $16,852.18 / $20,038.04
| Facility | | $2,651.00 | $16,852.18 | $20,038.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,131.59 / $12,308.20 / $19,372.73
| Facility | | $10,131.59 | $12,308.20 | $19,372.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $15,206.46
| Facility | | $1,350.00 | $5,713.00 | $15,206.46 |