- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,969.23 / $13,701.70 / $20,077.80
| Facility | | $2,969.23 | $13,701.70 | $20,077.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,879.61 / $29,879.61 / $29,879.61
| Facility | | $29,879.61 | $29,879.61 | $29,879.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $9,630.81 / $18,126.66
| Facility | | $2,200.00 | $9,630.81 | $18,126.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,600.51 / $16,369.49 / $22,932.46
| Facility | | $8,600.51 | $16,369.49 | $22,932.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,555.24 / $17,856.84 / $22,932.46
| Facility | | $15,555.24 | $17,856.84 | $22,932.46 |