- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,175.00 / $26,671.00 / $36,897.50
| Facility | | $5,175.00 | $26,671.00 | $36,897.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,683.00 / $10,237.25 / $22,341.18
| Facility | | $3,683.00 | $10,237.25 | $22,341.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,913.61 / $23,049.38 / $35,664.99
| Facility | | $10,913.61 | $23,049.38 | $35,664.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,610.75 / $22,138.50 / $50,772.44
| Facility | | $13,610.75 | $22,138.50 | $50,772.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,993.00 / $21,489.10 / $31,439.62
| Facility | | $6,993.00 | $21,489.10 | $31,439.62 |