- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.00 / $7,624.00 / $37,312.40
| Facility | | $2,120.00 | $7,624.00 | $37,312.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,281.04 / $22,281.04 / $22,281.04
| Facility | | $22,281.04 | $22,281.04 | $22,281.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,907.80 / $45,183.07 / $79,253.45
| Facility | | $14,907.80 | $45,183.07 | $79,253.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,942.00 / $41,082.17 / $64,563.51
| Facility | | $19,942.00 | $41,082.17 | $64,563.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,809.05 / $55,743.83 / $71,974.62
| Facility | | $28,809.05 | $55,743.83 | $71,974.62 |