- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $8,517.00 / $18,917.59
| Facility | | $1,650.00 | $8,517.00 | $18,917.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,423.00 / $11,573.00 / $19,405.63
| Facility | | $7,423.00 | $11,573.00 | $19,405.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,069.03 / $14,559.82 / $25,834.33
| Facility | | $10,069.03 | $14,559.82 | $25,834.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,685.00 / $13,225.00 / $19,529.00
| Facility | | $7,685.00 | $13,225.00 | $19,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,958.00 / $9,472.00 / $25,663.26
| Facility | | $4,958.00 | $9,472.00 | $25,663.26 |