- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,091.30 / $14,713.60 / $19,737.00
| Facility | | $7,091.30 | $14,713.60 | $19,737.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,708.79 / $15,708.79 / $15,708.79
| Facility | | $15,708.79 | $15,708.79 | $15,708.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $16,632.66 / $19,777.00
| Facility | | $2,651.00 | $16,632.66 | $19,777.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,506.53 / $15,193.35 / $23,913.87
| Facility | | $12,506.53 | $15,193.35 | $23,913.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $18,770.98
| Facility | | $1,350.00 | $5,713.00 | $18,770.98 |