- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,242.00 / $7,137.00 / $23,834.00
| Facility | | $5,242.00 | $7,137.00 | $23,834.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,334.42 / $21,550.59 / $26,937.18
| Facility | | $15,334.42 | $21,550.59 | $26,937.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,216.50 / $18,547.33 / $25,459.52
| Facility | | $10,216.50 | $18,547.33 | $25,459.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,354.95 / $18,725.59 / $20,576.24
| Facility | | $12,354.95 | $18,725.59 | $20,576.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,902.00 / $42,902.00 / $42,902.00
| Facility | | $42,902.00 | $42,902.00 | $42,902.00 |