- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,758.00 / $13,218.10 / $21,945.70
| Facility | | $3,758.00 | $13,218.10 | $21,945.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,903.57 / $18,903.57 / $18,903.57
| Facility | | $18,903.57 | $18,903.57 | $18,903.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,494.00 / $14,412.36 / $22,327.47
| Facility | | $3,494.00 | $14,412.36 | $22,327.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,804.60 / $14,752.15 / $24,739.27
| Facility | | $9,804.60 | $14,752.15 | $24,739.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,893.00 / $13,878.79 / $26,395.49
| Facility | | $2,893.00 | $13,878.79 | $26,395.49 |