- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $17,051.00 / $40,745.90
| Facility | | $4,098.00 | $17,051.00 | $40,745.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,292.64 / $13,495.00 / $29,457.85
| Facility | | $4,292.64 | $13,495.00 | $29,457.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,948.69 / $38,017.68 / $52,992.27
| Facility | | $24,948.69 | $38,017.68 | $52,992.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,500.00 / $12,500.00 / $12,500.00
| Facility | | $12,500.00 | $12,500.00 | $12,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,411.00 / $21,892.00 / $44,841.66
| Facility | | $13,411.00 | $21,892.00 | $44,841.66 |