- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,790.00 / $14,035.20 / $27,276.40
| Facility | | $3,790.00 | $14,035.20 | $27,276.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,185.00 / $3,200.00 / $23,977.46
| Facility | | $2,185.00 | $3,200.00 | $23,977.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,042.30 / $30,246.30 / $43,018.88
| Facility | | $11,042.30 | $30,246.30 | $43,018.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,722.70 / $19,378.79 / $35,581.17
| Facility | | $3,722.70 | $19,378.79 | $35,581.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,998.00 / $2,759.40 / $33,607.00
| Facility | | $1,998.00 | $2,759.40 | $33,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,831.72 / $20,026.89 / $32,283.84
| Facility | | $4,831.72 | $20,026.89 | $32,283.84 |