- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,686.77 / $12,976.50 / $22,835.00
| Facility | | $7,686.77 | $12,976.50 | $22,835.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,591.10 / $8,320.06 / $13,573.78
| Facility | | $5,591.10 | $8,320.06 | $13,573.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,992.32 / $11,961.20 / $16,806.87
| Facility | | $6,992.32 | $11,961.20 | $16,806.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,648.60 / $23,648.60 / $27,753.64
| Facility | | $23,648.60 | $23,648.60 | $27,753.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $11,308.94 / $16,153.53
| Facility | | $1,787.00 | $11,308.94 | $16,153.53 |