- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,645.00 / $6,906.00 / $18,810.50
| Facility | | $1,645.00 | $6,906.00 | $18,810.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,465.97 / $12,073.00 / $14,440.58
| Facility | | $11,465.97 | $12,073.00 | $14,440.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,770.43 / $10,293.79 / $16,224.06
| Facility | | $4,770.43 | $10,293.79 | $16,224.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,230.00 / $20,709.84 / $32,548.67
| Facility | | $9,230.00 | $20,709.84 | $32,548.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $11,629.00 / $30,185.22
| Facility | | $3,800.00 | $11,629.00 | $30,185.22 |