- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $13,489.63 / $28,183.83
| Facility | | $5,754.40 | $13,489.63 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $23,442.29 / $29,512.09
| Facility | | $15,848.93 | $23,442.29 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $18,620.87 / $23,988.33
| Facility | | $13,182.57 | $18,620.87 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $17,782.79 / $44,668.36
| Facility | | $10,000.00 | $17,782.79 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $14,791.08 / $23,988.33
| Facility | | $5,623.41 | $14,791.08 | $23,988.33 |