- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.00 / $5,481.00 / $23,443.30
| Facility | | $2,120.00 | $5,481.00 | $23,443.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,934.96 / $9,934.96 / $33,941.31
| Facility | | $9,934.96 | $9,934.96 | $33,941.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,243.20 / $20,305.59 / $34,254.22
| Facility | | $10,243.20 | $20,305.59 | $34,254.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,805.00 / $26,465.57 / $40,565.19
| Facility | | $14,805.00 | $26,465.57 | $40,565.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,032.15 / $34,243.69 / $55,007.81
| Facility | | $12,032.15 | $34,243.69 | $55,007.81 |