- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,922.00 / $10,612.60 / $19,104.50
| Facility | | $2,922.00 | $10,612.60 | $19,104.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,653.64 / $15,706.78 / $22,349.18
| Facility | | $12,653.64 | $15,706.78 | $22,349.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,904.00 / $9,900.00 / $18,100.23
| Facility | | $3,904.00 | $9,900.00 | $18,100.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,429.00 / $13,752.35 / $19,712.93
| Facility | | $8,429.00 | $13,752.35 | $19,712.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,429.00 / $15,690.76 / $21,969.94
| Facility | | $8,429.00 | $15,690.76 | $21,969.94 |