- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,379.56 / $16,787.00 / $24,893.00
| Facility | | $8,379.56 | $16,787.00 | $24,893.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,414.59 / $9,468.57 / $15,655.75
| Facility | | $6,414.59 | $9,468.57 | $15,655.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,622.53 / $13,039.24 / $18,143.86
| Facility | | $7,622.53 | $13,039.24 | $18,143.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,514.00 / $28,514.00 / $33,463.60
| Facility | | $28,514.00 | $28,514.00 | $33,463.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $12,328.20 / $17,609.41
| Facility | | $1,787.00 | $12,328.20 | $17,609.41 |