- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.00 / $8,642.00 / $20,407.70
| Facility | | $1,650.00 | $8,642.00 | $20,407.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,463.00 / $11,682.00 / $20,002.91
| Facility | | $7,463.00 | $11,682.00 | $20,002.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,862.15 / $15,363.49 / $21,383.27
| Facility | | $10,862.15 | $15,363.49 | $21,383.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,464.00 / $15,028.00 / $21,095.00
| Facility | | $8,464.00 | $15,028.00 | $21,095.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,958.00 / $9,472.00 / $27,684.72
| Facility | | $4,958.00 | $9,472.00 | $27,684.72 |