- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.00 / $11,971.00 / $22,783.80
| Facility | | $2,005.00 | $11,971.00 | $22,783.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,206.00 / $20,680.57 / $22,696.23
| Facility | | $7,206.00 | $20,680.57 | $22,696.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,782.24 / $15,746.21 / $25,004.24
| Facility | | $9,782.24 | $15,746.21 | $25,004.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,222.04 / $12,442.39 / $25,217.67
| Facility | | $6,222.04 | $12,442.39 | $25,217.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,584.68 / $11,292.00 / $22,095.61
| Facility | | $5,584.68 | $11,292.00 | $22,095.61 |