- 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
- $21,868.49 / $30,733.39 / $38,415.24
| Facility | | $21,868.49 | $30,733.39 | $38,415.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,424.20 / $26,186.10 / $35,945.11
| Facility | | $14,424.20 | $26,186.10 | $35,945.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,443.36 / $26,214.54 / $28,818.62
| Facility | | $17,443.36 | $26,214.54 | $28,818.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60,571.34 / $60,571.34 / $60,571.34
| Facility | | $60,571.34 | $60,571.34 | $60,571.34 |