- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,588.00 / $17,369.50 / $29,070.40
| Facility | | $12,588.00 | $17,369.50 | $29,070.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,708.06 / $20,708.06 / $20,708.06
| Facility | | $20,708.06 | $20,708.06 | $20,708.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.00 / $19,702.25 / $30,344.67
| Facility | | $3,272.00 | $19,702.25 | $30,344.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,883.75 / $19,541.41 / $32,770.83
| Facility | | $12,883.75 | $19,541.41 | $32,770.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $19,927.05 / $35,068.65
| Facility | | $4,062.00 | $19,927.05 | $35,068.65 |