- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,185.00 / $11,632.10 / $20,738.00
| Facility | | $2,185.00 | $11,632.10 | $20,738.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,941.00 / $12,257.95 / $20,992.91
| Facility | | $5,941.00 | $12,257.95 | $20,992.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,756.96 / $10,840.72 / $15,412.93
| Facility | | $9,756.96 | $10,840.72 | $15,412.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.13 / $13,375.54 / $36,990.33
| Facility | | $6,693.13 | $13,375.54 | $36,990.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.13 / $12,770.48 / $17,948.28
| Facility | | $6,693.13 | $12,770.48 | $17,948.28 |