- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,130.40 / $25,120.00 / $51,037.10
| Facility | | $13,130.40 | $25,120.00 | $51,037.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,397.21 / $38,397.21 / $40,796.33
| Facility | | $38,397.21 | $38,397.21 | $40,796.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $14,839.37 / $22,542.45
| Facility | | $7,500.00 | $14,839.37 | $22,542.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $14,288.90 / $40,796.33
| Facility | | $7,500.00 | $14,288.90 | $40,796.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,339.00 / $12,339.00 / $12,339.00
| Facility | | $12,339.00 | $12,339.00 | $12,339.00 |