- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,158.00 / $4,205.00 / $12,930.00
| Facility | | $4,158.00 | $4,205.00 | $12,930.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,454.19 / $22,041.18 / $27,550.40
| Facility | | $15,454.19 | $22,041.18 | $27,550.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,457.29 / $26,059.59 / $27,644.00
| Facility | | $10,457.29 | $26,059.59 | $27,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,646.14 / $19,125.71 / $28,799.00
| Facility | | $12,646.14 | $19,125.71 | $28,799.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,610.00 / $16,256.00 / $49,349.49
| Facility | | $6,610.00 | $16,256.00 | $49,349.49 |