- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,675.00 / $10,049.70 / $17,744.50
| Facility | | $3,675.00 | $10,049.70 | $17,744.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,212.88 / $13,563.99 / $18,794.09
| Facility | | $11,212.88 | $13,563.99 | $18,794.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.00 / $11,630.46 / $18,308.62
| Facility | | $3,272.00 | $11,630.46 | $18,308.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,816.41 / $12,134.05 / $20,348.72
| Facility | | $7,816.41 | $12,134.05 | $20,348.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $12,373.50 / $21,775.53
| Facility | | $4,062.00 | $12,373.50 | $21,775.53 |