- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.00 / $5,868.00 / $23,037.20
| Facility | | $2,120.00 | $5,868.00 | $23,037.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,413.78 / $10,413.78 / $15,807.55
| Facility | | $10,413.78 | $10,413.78 | $15,807.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,210.34 / $23,145.70 / $55,636.67
| Facility | | $14,210.34 | $23,145.70 | $55,636.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,043.05 / $26,837.00 / $39,862.47
| Facility | | $19,043.05 | $26,837.00 | $39,862.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,027.00 / $29,114.41 / $44,438.20
| Facility | | $15,027.00 | $29,114.41 | $44,438.20 |