- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,185.00 / $17,475.90 / $31,156.30
| Facility | | $2,185.00 | $17,475.90 | $31,156.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,928.07 / $16,840.62 / $29,479.03
| Facility | | $6,928.07 | $16,840.62 | $29,479.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,658.69 / $16,286.89 / $23,156.09
| Facility | | $14,658.69 | $16,286.89 | $23,156.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,671.10 / $20,095.16 / $51,943.22
| Facility | | $9,671.10 | $20,095.16 | $51,943.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,671.10 / $19,186.13 / $26,965.16
| Facility | | $9,671.10 | $19,186.13 | $26,965.16 |