- 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
- $23,010.94 / $32,338.96 / $40,422.12
| Facility | | $23,010.94 | $32,338.96 | $40,422.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,910.00 / $27,068.04 / $37,155.72
| Facility | | $14,910.00 | $27,068.04 | $37,155.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,030.84 / $27,388.26 / $30,259.77
| Facility | | $18,030.84 | $27,388.26 | $30,259.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62,611.35 / $62,611.35 / $62,611.35
| Facility | | $62,611.35 | $62,611.35 | $62,611.35 |