- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,242.00 / $7,137.00 / $15,870.00
| Facility | | $5,242.00 | $7,137.00 | $15,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,531.39 / $21,827.41 / $27,283.20
| Facility | | $15,531.39 | $21,827.41 | $27,283.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,297.00 / $18,693.47 / $25,660.12
| Facility | | $10,297.00 | $18,693.47 | $25,660.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,452.29 / $18,951.33 / $20,824.70
| Facility | | $12,452.29 | $18,951.33 | $20,824.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,240.05 / $43,240.05 / $43,240.05
| Facility | | $43,240.05 | $43,240.05 | $43,240.05 |