- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,740.00 / $52,643.00 / $52,643.00
| Facility | | $3,740.00 | $52,643.00 | $52,643.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,551.81 / $19,045.34 / $23,805.76
| Facility | | $13,551.81 | $19,045.34 | $23,805.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,817.60 / $19,481.46 / $36,632.00
| Facility | | $7,817.60 | $19,481.46 | $36,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,498.27 / $16,682.48 / $44,693.00
| Facility | | $9,498.27 | $16,682.48 | $44,693.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,775.00 / $17,868.00 / $32,828.33
| Facility | | $17,775.00 | $17,868.00 | $32,828.33 |