- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,295.00 / $12,264.00 / $18,798.80
| Facility | | $2,295.00 | $12,264.00 | $18,798.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,188.33 / $12,905.00 / $21,096.51
| Facility | | $11,188.33 | $12,905.00 | $21,096.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.00 / $10,366.00 / $18,221.47
| Facility | | $3,027.00 | $10,366.00 | $18,221.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,964.75 / $13,337.12 / $21,496.71
| Facility | | $8,964.75 | $13,337.12 | $21,496.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,159.06 / $13,079.51 / $20,343.32
| Facility | | $8,159.06 | $13,079.51 | $20,343.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,724.00 / $13,125.00 / $21,086.45
| Facility | | $5,724.00 | $13,125.00 | $21,086.45 |