- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.00 / $10,653.40 / $19,466.09
| Facility | | $1,973.00 | $10,653.40 | $19,466.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,340.10 / $11,340.10 / $11,340.10
| Facility | | $11,340.10 | $11,340.10 | $11,340.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,834.95 / $10,444.02 / $17,664.66
| Facility | | $3,834.95 | $10,444.02 | $17,664.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,345.72 / $18,367.66 / $29,194.88
| Facility | | $11,345.72 | $18,367.66 | $29,194.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,400.55 / $17,439.15 / $25,462.58
| Facility | | $13,400.55 | $17,439.15 | $25,462.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,400.55 / $16,212.02 / $25,462.58
| Facility | | $13,400.55 | $16,212.02 | $25,462.58 |