- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,242.00 / $7,137.00 / $23,834.00
| Facility | | $5,242.00 | $7,137.00 | $23,834.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,327.04 / $39,810.07 / $49,760.65
| Facility | | $28,327.04 | $39,810.07 | $49,760.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,973.20 / $32,629.06 / $44,789.21
| Facility | | $17,973.20 | $32,629.06 | $44,789.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,735.22 / $32,770.41 / $36,965.75
| Facility | | $21,735.22 | $32,770.41 | $36,965.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75,474.60 / $75,474.60 / $75,474.60
| Facility | | $75,474.60 | $75,474.60 | $75,474.60 |