- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,158.00 / $4,205.00 / $11,156.00
| Facility | | $4,158.00 | $4,205.00 | $11,156.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,907.64 / $20,950.81 / $26,187.49
| Facility | | $14,907.64 | $20,950.81 | $26,187.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,711.10 / $17,629.81 / $24,200.06
| Facility | | $9,711.10 | $17,629.81 | $24,200.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,743.77 / $18,236.43 / $20,037.87
| Facility | | $11,743.77 | $18,236.43 | $20,037.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,671.00 / $16,757.00 / $40,779.68
| Facility | | $16,671.00 | $16,757.00 | $40,779.68 |