- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,316.00 / $12,090.10 / $22,965.40
| Facility | | $4,316.00 | $12,090.10 | $22,965.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,024.70 / $30,024.70 / $30,024.70
| Facility | | $30,024.70 | $30,024.70 | $30,024.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.56 / $10,467.48 / $17,649.89
| Facility | | $2,884.56 | $10,467.48 | $17,649.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,042.27 / $18,779.36 / $27,723.25
| Facility | | $12,042.27 | $18,779.36 | $27,723.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $9,753.00 / $26,798.99
| Facility | | $3,300.00 | $9,753.00 | $26,798.99 |