- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.00 / $7,043.00 / $30,277.70
| Facility | | $2,120.00 | $7,043.00 | $30,277.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,383.92 / $34,383.92 / $34,383.92
| Facility | | $34,383.92 | $34,383.92 | $34,383.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,345.17 / $15,649.56 / $30,459.25
| Facility | | $9,345.17 | $15,649.56 | $30,459.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,833.00 / $33,525.49 / $52,390.94
| Facility | | $15,833.00 | $33,525.49 | $52,390.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,653.75 / $45,234.08 / $58,404.78
| Facility | | $24,653.75 | $45,234.08 | $58,404.78 |