- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,421.00 / $11,940.00 / $30,952.90
| Facility | | $2,421.00 | $11,940.00 | $30,952.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,198.00 / $19,861.18 / $28,020.90
| Facility | | $9,198.00 | $19,861.18 | $28,020.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,791.79 / $15,870.72 / $26,419.21
| Facility | | $5,791.79 | $15,870.72 | $26,419.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,262.86 / $26,967.68 / $48,102.72
| Facility | | $19,262.86 | $26,967.68 | $48,102.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,936.00 / $14,967.00 / $36,031.68
| Facility | | $9,936.00 | $14,967.00 | $36,031.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,936.00 / $14,153.00 / $33,306.69
| Facility | | $9,936.00 | $14,153.00 | $33,306.69 |