- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,421.00 / $11,558.00 / $20,956.80
| Facility | | $2,421.00 | $11,558.00 | $20,956.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,654.93 / $12,525.00 / $20,165.02
| Facility | | $9,654.93 | $12,525.00 | $20,165.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,673.03 / $12,805.08 / $21,315.99
| Facility | | $4,673.03 | $12,805.08 | $21,315.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,041.99 / $18,258.56 / $32,568.12
| Facility | | $13,041.99 | $18,258.56 | $32,568.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,936.00 / $14,933.00 / $24,395.38
| Facility | | $9,936.00 | $14,933.00 | $24,395.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,936.00 / $13,703.00 / $23,449.45
| Facility | | $9,936.00 | $13,703.00 | $23,449.45 |