- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,742.03 / $11,914.00 / $15,981.60
| Facility | | $5,742.03 | $11,914.00 | $15,981.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,511.38 / $16,511.38 / $26,240.57
| Facility | | $16,511.38 | $16,511.38 | $26,240.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $12,128.93 / $14,421.86
| Facility | | $2,651.00 | $12,128.93 | $14,421.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,126.90 / $12,302.50 / $19,363.75
| Facility | | $10,126.90 | $12,302.50 | $19,363.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $15,199.42
| Facility | | $1,350.00 | $5,713.00 | $15,199.42 |