- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.00 / $5,868.00 / $18,047.00
| Facility | | $2,120.00 | $5,868.00 | $18,047.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,020.43 / $13,020.43 / $13,020.43
| Facility | | $13,020.43 | $13,020.43 | $13,020.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,209.00 / $18,347.64 / $36,134.14
| Facility | | $9,209.00 | $18,347.64 | $36,134.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,918.04 / $21,148.05 / $31,227.66
| Facility | | $14,918.04 | $21,148.05 | $31,227.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,413.00 / $22,807.79 / $34,812.22
| Facility | | $10,413.00 | $22,807.79 | $34,812.22 |