- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,613.04 / $17,871.00 / $23,972.40
| Facility | | $8,613.04 | $17,871.00 | $23,972.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,899.84 / $19,215.25 / $23,303.97
| Facility | | $9,899.84 | $19,215.25 | $23,303.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $17,426.52 / $20,720.93
| Facility | | $2,651.00 | $17,426.52 | $20,720.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,190.35 / $18,453.75 / $29,045.64
| Facility | | $15,190.35 | $18,453.75 | $29,045.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $5,713.00 / $22,799.12
| Facility | | $1,350.00 | $5,713.00 | $22,799.12 |