- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,194.00 / $30,622.70 / $60,501.10
| Facility | | $5,194.00 | $30,622.70 | $60,501.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,318.90 / $29,318.90 / $41,451.80
| Facility | | $29,318.90 | $29,318.90 | $41,451.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,319.47 / $24,325.47 / $62,646.04
| Facility | | $6,319.47 | $24,325.47 | $62,646.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,115.69 / $32,737.50 / $54,016.88
| Facility | | $21,115.69 | $32,737.50 | $54,016.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,535.00 / $35,389.24 / $61,212.58
| Facility | | $3,535.00 | $35,389.24 | $61,212.58 |