- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.00 / $27,502.80 / $52,899.00
| Facility | | $3,822.00 | $27,502.80 | $52,899.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,115.70 / $67,254.92
| Facility | | $5,840.42 | $25,115.70 | $67,254.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,540.00 / $25,695.73 / $38,826.55
| Facility | | $15,540.00 | $25,695.73 | $38,826.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,490.57 / $36,490.57 / $36,490.57
| Facility | | $36,490.57 | $36,490.57 | $36,490.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,390.10 / $25,886.13 / $39,974.26
| Facility | | $22,390.10 | $25,886.13 | $39,974.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,115.70 / $67,254.92
| Facility | | $5,840.42 | $25,115.70 | $67,254.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,115.70 / $52,560.32
| Facility | | $5,840.42 | $25,115.70 | $52,560.32 |