- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,421.00 / $8,228.00 / $17,960.00
| Facility | | $2,421.00 | $8,228.00 | $17,960.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,814.30 / $7,757.10 / $12,963.30
| Facility | | $2,814.30 | $7,757.10 | $12,963.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,177.01 / $15,647.63 / $27,910.95
| Facility | | $11,177.01 | $15,647.63 | $27,910.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,549.00 / $9,424.00 / $20,906.89
| Facility | | $6,549.00 | $9,424.00 | $20,906.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,427.00 / $8,752.00 / $19,490.38
| Facility | | $5,427.00 | $8,752.00 | $19,490.38 |