- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,616.60 / $28,236.00 / $36,866.10
| Facility | | $13,616.60 | $28,236.00 | $36,866.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,452.22 / $69,047.88
| Facility | | $5,840.42 | $25,452.22 | $69,047.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,954.28 / $26,380.75 / $39,861.62
| Facility | | $15,954.28 | $26,380.75 | $39,861.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,463.37 / $37,463.37 / $37,463.37
| Facility | | $37,463.37 | $37,463.37 | $37,463.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,987.00 / $26,576.23 / $41,039.94
| Facility | | $22,987.00 | $26,576.23 | $41,039.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,452.22 / $69,047.88
| Facility | | $5,840.42 | $25,452.22 | $69,047.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,052.99 / $53,961.53
| Facility | | $5,840.42 | $20,052.99 | $53,961.53 |