- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,896.00 / $15,614.00 / $25,844.70
| Facility | | $7,896.00 | $15,614.00 | $25,844.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,204.37 / $27,014.03 / $35,028.87
| Facility | | $18,204.37 | $27,014.03 | $35,028.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,802.18 / $22,596.50 / $33,170.40
| Facility | | $15,802.18 | $22,596.50 | $33,170.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,628.15 / $22,343.78 / $46,855.61
| Facility | | $11,628.15 | $22,343.78 | $46,855.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,802.18 / $24,602.17 / $33,353.26
| Facility | | $15,802.18 | $24,602.17 | $33,353.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $16,763.00 / $28,528.60
| Facility | | $4,870.00 | $16,763.00 | $28,528.60 |