- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,175.00 / $75,348.80 / $104,240.00
| Facility | | $5,175.00 | $75,348.80 | $104,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,301.50 / $7,301.50 / $42,246.48
| Facility | | $7,301.50 | $7,301.50 | $42,246.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,509.03 / $64,922.17 / $100,759.28
| Facility | | $29,509.03 | $64,922.17 | $100,759.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,452.05 / $62,544.00 / $143,438.41
| Facility | | $38,452.05 | $62,544.00 | $143,438.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,780.00 / $60,709.38 / $88,353.82
| Facility | | $19,780.00 | $60,709.38 | $88,353.82 |