- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,316.00 / $10,364.10 / $19,686.90
| Facility | | $4,316.00 | $10,364.10 | $19,686.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,308.00 / $12,069.29 / $14,628.24
| Facility | | $2,308.00 | $12,069.29 | $14,628.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.56 / $10,180.95 / $14,760.62
| Facility | | $2,884.56 | $10,180.95 | $14,760.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,936.26 / $16,098.44 / $23,765.50
| Facility | | $10,936.26 | $16,098.44 | $23,765.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $9,753.00 / $22,973.19
| Facility | | $3,300.00 | $9,753.00 | $22,973.19 |