- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,178.70 / $21,119.50 / $28,330.00
| Facility | | $10,178.70 | $21,119.50 | $28,330.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,129.56 / $22,129.56 / $22,129.56
| Facility | | $22,129.56 | $22,129.56 | $22,129.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $23,093.21 / $27,458.89
| Facility | | $3,897.00 | $23,093.21 | $27,458.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,951.59 / $21,808.20 / $34,325.44
| Facility | | $17,951.59 | $21,808.20 | $34,325.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $26,943.46 / $34,027.68
| Facility | | $1,350.00 | $26,943.46 | $34,027.68 |