- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,442.80 / $30,492.00 / $30,492.00
| Facility | | $27,442.80 | $30,492.00 | $30,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,012.61 / $21,012.61 / $21,012.61
| Facility | | $21,012.61 | $21,012.61 | $21,012.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,579.43 / $14,903.85 / $28,161.53
| Facility | | $7,579.43 | $14,903.85 | $28,161.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,029.97 / $33,572.74 / $52,761.90
| Facility | | $19,029.97 | $33,572.74 | $52,761.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $45,554.38 / $58,818.33
| Facility | | $6,965.00 | $45,554.38 | $58,818.33 |