- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,242.00 / $7,137.00 / $15,870.00
| Facility | | $5,242.00 | $7,137.00 | $15,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,712.57 / $34,730.39 / $43,411.30
| Facility | | $24,712.57 | $34,730.39 | $43,411.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,661.10 / $28,431.61 / $39,027.46
| Facility | | $15,661.10 | $28,431.61 | $39,027.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,939.18 / $28,707.98 / $32,406.29
| Facility | | $18,939.18 | $28,707.98 | $32,406.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65,765.42 / $65,765.42 / $65,765.42
| Facility | | $65,765.42 | $65,765.42 | $65,765.42 |