- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.00 / $11,791.33 / $24,368.30
| Facility | | $1,584.00 | $11,791.33 | $24,368.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,769.37 / $8,769.37 / $8,769.37
| Facility | | $8,769.37 | $8,769.37 | $8,769.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,081.00 / $9,667.62 / $14,117.70
| Facility | | $4,081.00 | $9,667.62 | $14,117.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,064.04 / $12,143.16 / $21,276.43
| Facility | | $9,064.04 | $12,143.16 | $21,276.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,719.00 / $7,791.00 / $17,867.24
| Facility | | $2,719.00 | $7,791.00 | $17,867.24 |