- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,758.00 / $15,067.40 / $26,241.30
| Facility | | $3,758.00 | $15,067.40 | $26,241.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,427.83 / $24,427.83 / $24,427.83
| Facility | | $24,427.83 | $24,427.83 | $24,427.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.00 / $17,835.04 / $27,738.75
| Facility | | $3,272.00 | $17,835.04 | $27,738.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,559.24 / $17,944.34 / $30,092.55
| Facility | | $11,559.24 | $17,944.34 | $30,092.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $18,298.46 / $32,202.57
| Facility | | $4,062.00 | $18,298.46 | $32,202.57 |