- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.00 / $5,291.00 / $20,354.80
| Facility | | $2,120.00 | $5,291.00 | $20,354.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,398.74 / $14,398.74 / $14,398.74
| Facility | | $14,398.74 | $14,398.74 | $14,398.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,797.41 / $15,053.23 / $23,703.69
| Facility | | $7,797.41 | $15,053.23 | $23,703.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,337.00 / $22,411.25 / $35,220.85
| Facility | | $10,337.00 | $22,411.25 | $35,220.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,312.28 / $30,409.51 / $39,263.76
| Facility | | $16,312.28 | $30,409.51 | $39,263.76 |