- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $11,864.60 / $20,046.50
| Facility | | $1,650.00 | $11,864.60 | $20,046.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,210.21 / $14,360.58 / $21,869.01
| Facility | | $8,210.21 | $14,360.58 | $21,869.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,956.13 / $16,112.46 / $27,376.02
| Facility | | $10,956.13 | $16,112.46 | $27,376.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,768.00 / $16,187.00 / $21,159.22
| Facility | | $11,768.00 | $16,187.00 | $21,159.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $11,996.00 / $27,194.75
| Facility | | $5,700.00 | $11,996.00 | $27,194.75 |