- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,295.00 / $11,807.60 / $17,002.40
| Facility | | $2,295.00 | $11,807.60 | $17,002.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,214.04 / $10,720.48 / $15,664.26
| Facility | | $10,214.04 | $10,720.48 | $15,664.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.00 / $9,739.09 / $16,774.93
| Facility | | $3,027.00 | $9,739.09 | $16,774.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,108.10 / $12,062.66 / $19,442.55
| Facility | | $8,108.10 | $12,062.66 | $19,442.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.76 / $14,134.63 / $18,932.46
| Facility | | $7,413.76 | $14,134.63 | $18,932.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,264.00 / $12,612.06 / $19,377.00
| Facility | | $7,264.00 | $12,612.06 | $19,377.00 |