- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,302.04 / $13,076.00 / $17,540.30
| Facility | | $6,302.04 | $13,076.00 | $17,540.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,913.73 / $2,913.73 / $14,282.66
| Facility | | $2,913.73 | $2,913.73 | $14,282.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $14,471.65 / $17,207.47
| Facility | | $2,651.00 | $14,471.65 | $17,207.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,114.57 / $13,502.35 / $21,252.29
| Facility | | $11,114.57 | $13,502.35 | $21,252.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $16,681.80
| Facility | | $1,350.00 | $5,713.00 | $16,681.80 |