- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,182.00 / $24,854.80 / $41,279.80
| Facility | | $3,182.00 | $24,854.80 | $41,279.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $21,643.21 / $38,648.32
| Facility | | $1,474.01 | $21,643.21 | $38,648.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,551.62 / $25,381.15 / $37,959.85
| Facility | | $18,551.62 | $25,381.15 | $37,959.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,216.15 / $27,420.42 / $70,062.08
| Facility | | $16,216.15 | $27,420.42 | $70,062.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,216.15 / $28,858.78 / $48,616.48
| Facility | | $16,216.15 | $28,858.78 | $48,616.48 |