- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.73 / $16,723.00 / $36,225.00
| Facility | | $1,028.73 | $16,723.00 | $36,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,650.00 / $40,050.00 / $63,916.00
| Facility | | $3,650.00 | $40,050.00 | $63,916.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.86 / $1,030.90 / $1,189.50
| Facility | | $808.86 | $1,030.90 | $1,189.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,402.94 / $33,402.94 / $33,402.94
| Facility | | $33,402.94 | $33,402.94 | $33,402.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,200.00 / $23,565.00 / $74,555.00
| Facility | | $14,200.00 | $23,565.00 | $74,555.00 |