- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,354.00 / $23,199.60 / $38,400.60
| Facility | | $10,354.00 | $23,199.60 | $38,400.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,302.68 / $40,515.30 / $52,535.87
| Facility | | $27,302.68 | $40,515.30 | $52,535.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,545.70 / $30,816.98 / $49,273.11
| Facility | | $15,545.70 | $30,816.98 | $49,273.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,273.30 / $33,198.86 / $69,619.05
| Facility | | $17,273.30 | $33,198.86 | $69,619.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,648.00 / $32,979.62 / $49,285.28
| Facility | | $17,648.00 | $32,979.62 | $49,285.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,346.00 / $20,809.61 / $42,388.39
| Facility | | $4,346.00 | $20,809.61 | $42,388.39 |