- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.00 / $5,414.00 / $12,701.40
| Facility | | $896.00 | $5,414.00 | $12,701.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,410.00 / $8,234.00 / $10,407.43
| Facility | | $7,410.00 | $8,234.00 | $10,407.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,178.00 / $9,654.00 / $14,604.00
| Facility | | $2,178.00 | $9,654.00 | $14,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,292.58 / $13,219.56 / $18,724.03
| Facility | | $9,292.58 | $13,219.56 | $18,724.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $13,215.00 / $20,087.93
| Facility | | $5,700.00 | $13,215.00 | $20,087.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,695.52 / $27,165.85 / $27,165.85
| Facility | | $18,695.52 | $27,165.85 | $27,165.85 |