- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,048.00 / $12,765.09 / $24,068.03
| Facility | | $6,048.00 | $12,765.09 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,543.08 / $22,420.13 / $42,088.31
| Facility | | $16,543.08 | $22,420.13 | $42,088.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.10 / $1,675.33 / $19,047.20
| Facility | | $458.10 | $1,675.33 | $19,047.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.95 / $1,788.00 / $19,539.43
| Facility | | $919.95 | $1,788.00 | $19,539.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |