- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,566.75 / $13,625.20 / $18,277.00
| Facility | | $6,566.75 | $13,625.20 | $18,277.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,069.51 / $14,128.89 / $27,351.49
| Facility | | $14,069.51 | $14,128.89 | $27,351.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $16,637.55 / $19,782.81
| Facility | | $2,651.00 | $16,637.55 | $19,782.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,581.42 / $14,069.50 / $22,144.96
| Facility | | $11,581.42 | $14,069.50 | $22,144.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $17,382.50
| Facility | | $1,350.00 | $5,713.00 | $17,382.50 |