- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,389.00 / $10,190.00 / $38,392.90
| Facility | | $3,389.00 | $10,190.00 | $38,392.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,819.14 / $39,072.92 / $57,638.92
| Facility | | $28,819.14 | $39,072.92 | $57,638.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,024.06 / $31,572.59 / $52,116.86
| Facility | | $26,024.06 | $31,572.59 | $52,116.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,300.00 / $17,162.00 / $45,740.97
| Facility | | $4,300.00 | $17,162.00 | $45,740.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $28,874.43 / $45,740.97
| Facility | | $5,700.00 | $28,874.43 | $45,740.97 |