- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.00 / $8,277.00 / $21,625.40
| Facility | | $2,120.00 | $8,277.00 | $21,625.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,487.06 / $16,403.00 / $27,295.03
| Facility | | $14,487.06 | $16,403.00 | $27,295.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,508.53 / $16,353.98 / $28,555.52
| Facility | | $8,508.53 | $16,353.98 | $28,555.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,020.00 / $23,997.97 / $37,419.51
| Facility | | $14,020.00 | $23,997.97 | $37,419.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,654.00 / $27,330.14 / $41,714.82
| Facility | | $12,654.00 | $27,330.14 | $41,714.82 |