- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,740.00 / $52,643.00 / $52,643.00
| Facility | | $3,740.00 | $52,643.00 | $52,643.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,507.37 / $30,225.88 / $37,780.87
| Facility | | $21,507.37 | $30,225.88 | $37,780.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,382.30 / $30,856.69 / $36,632.00
| Facility | | $12,382.30 | $30,856.69 | $36,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,974.06 / $25,800.68 / $47,150.00
| Facility | | $14,974.06 | $25,800.68 | $47,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,034.00 / $6,034.00 / $51,996.82
| Facility | | $6,034.00 | $6,034.00 | $51,996.82 |