- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,175.00 / $32,567.60 / $45,055.00
| Facility | | $5,175.00 | $32,567.60 | $45,055.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,800.00 / $25,800.00 / $42,761.32
| Facility | | $25,800.00 | $25,800.00 | $42,761.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,217.01 / $28,145.79 / $43,550.81
| Facility | | $14,217.01 | $28,145.79 | $43,550.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,619.89 / $27,033.00 / $61,997.48
| Facility | | $16,619.89 | $27,033.00 | $61,997.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,523.00 / $26,240.03 / $38,390.46
| Facility | | $8,523.00 | $26,240.03 | $38,390.46 |