- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,242.00 / $7,137.00 / $31,438.00
| Facility | | $5,242.00 | $7,137.00 | $31,438.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,731.89 / $31,946.79 / $39,931.93
| Facility | | $22,731.89 | $31,946.79 | $39,931.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,816.20 / $26,897.75 / $36,921.97
| Facility | | $14,816.20 | $26,897.75 | $36,921.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,917.41 / $27,204.11 / $29,907.75
| Facility | | $17,917.41 | $27,204.11 | $29,907.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62,217.46 / $62,217.46 / $62,217.46
| Facility | | $62,217.46 | $62,217.46 | $62,217.46 |