- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,421.00 / $8,475.00 / $20,251.20
| Facility | | $2,421.00 | $8,475.00 | $20,251.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,869.72 / $10,603.84 / $17,651.68
| Facility | | $3,869.72 | $10,603.84 | $17,651.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,163.66 / $17,562.90 / $29,396.33
| Facility | | $12,163.66 | $17,562.90 | $29,396.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,549.00 / $9,499.00 / $23,574.04
| Facility | | $6,549.00 | $9,499.00 | $23,574.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,427.00 / $8,752.00 / $21,976.83
| Facility | | $5,427.00 | $8,752.00 | $21,976.83 |