- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,758.00 / $14,105.30 / $23,607.20
| Facility | | $3,758.00 | $14,105.30 | $23,607.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,346.65 / $17,346.65 / $17,346.65
| Facility | | $17,346.65 | $17,346.65 | $17,346.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,494.00 / $15,885.45 / $24,467.19
| Facility | | $3,494.00 | $15,885.45 | $24,467.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,462.52 / $15,869.03 / $26,612.26
| Facility | | $10,462.52 | $15,869.03 | $26,612.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $16,182.19 / $28,478.25
| Facility | | $4,062.00 | $16,182.19 | $28,478.25 |