- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,841.00 / $26,627.60 / $34,766.10
| Facility | | $12,841.00 | $26,627.60 | $34,766.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,316.50 / $65,114.82
| Facility | | $5,840.42 | $24,316.50 | $65,114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,045.50 / $24,878.07 / $37,591.06
| Facility | | $15,045.50 | $24,878.07 | $37,591.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,329.42 / $35,329.42 / $35,329.42
| Facility | | $35,329.42 | $35,329.42 | $35,329.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,677.63 / $25,062.41 / $38,702.25
| Facility | | $21,677.63 | $25,062.41 | $38,702.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,316.50 / $65,114.82
| Facility | | $5,840.42 | $24,316.50 | $65,114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,910.75 / $50,887.81
| Facility | | $5,840.42 | $18,910.75 | $50,887.81 |