- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,487.00 / $9,863.48 / $28,971.90
| Facility | | $3,487.00 | $9,863.48 | $28,971.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,837.94 / $18,995.57 / $31,332.85
| Facility | | $12,837.94 | $18,995.57 | $31,332.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,241.04 / $14,316.76 / $20,955.08
| Facility | | $8,241.04 | $14,316.76 | $20,955.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,297.95 / $27,323.07 / $39,702.26
| Facility | | $23,297.95 | $27,323.07 | $39,702.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,820.00 / $7,750.00 / $19,277.66
| Facility | | $2,820.00 | $7,750.00 | $19,277.66 |