- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.00 / $25,275.00 / $56,781.20
| Facility | | $4,206.00 | $25,275.00 | $56,781.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,687.00 / $15,875.00 / $37,754.18
| Facility | | $9,687.00 | $15,875.00 | $37,754.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,483.40 / $27,756.22 / $43,788.11
| Facility | | $17,483.40 | $27,756.22 | $43,788.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,974.07 / $17,903.02 / $44,161.88
| Facility | | $7,974.07 | $17,903.02 | $44,161.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,759.00 / $29,395.44 / $39,331.36
| Facility | | $7,759.00 | $29,395.44 | $39,331.36 |