- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,733.52 / $20,195.80 / $27,091.00
| Facility | | $9,733.52 | $20,195.80 | $27,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,660.44 / $35,660.44 / $35,660.44
| Facility | | $35,660.44 | $35,660.44 | $35,660.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $21,578.86 / $25,658.27
| Facility | | $3,897.00 | $21,578.86 | $25,658.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,166.46 / $20,854.40 / $32,824.19
| Facility | | $17,166.46 | $20,854.40 | $32,824.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $25,765.06 / $32,539.45
| Facility | | $1,350.00 | $25,765.06 | $32,539.45 |