- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.00 / $12,075.00 / $25,690.40
| Facility | | $2,005.00 | $12,075.00 | $25,690.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,703.00 / $17,610.41 / $24,772.91
| Facility | | $7,703.00 | $17,610.41 | $24,772.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,030.19 / $17,590.96 / $28,194.10
| Facility | | $11,030.19 | $17,590.96 | $28,194.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,589.31 / $12,394.61 / $28,434.76
| Facility | | $5,589.31 | $12,394.61 | $28,434.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,972.00 / $11,075.00 / $24,065.08
| Facility | | $5,972.00 | $11,075.00 | $24,065.08 |