- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,487.00 / $9,185.75 / $26,603.50
| Facility | | $3,487.00 | $9,185.75 | $26,603.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,119.00 / $13,175.10 / $25,486.36
| Facility | | $4,119.00 | $13,175.10 | $25,486.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,295.41 / $20,089.81 / $30,673.67
| Facility | | $12,295.41 | $20,089.81 | $30,673.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,567.35 / $13,067.95 / $19,361.71
| Facility | | $7,567.35 | $13,067.95 | $19,361.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,007.48 / $23,464.11 / $34,094.93
| Facility | | $20,007.48 | $23,464.11 | $34,094.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,820.00 / $7,583.00 / $17,701.75
| Facility | | $2,820.00 | $7,583.00 | $17,701.75 |