- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,091.80 / $25,361.30 / $40,835.00
| Facility | | $11,091.80 | $25,361.30 | $40,835.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,540.00 / $16,540.00 / $16,540.00
| Facility | | $16,540.00 | $16,540.00 | $16,540.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $14,630.83 / $35,724.58
| Facility | | $1,474.01 | $14,630.83 | $35,724.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,358.34 / $26,516.90 / $37,564.37
| Facility | | $18,358.34 | $26,516.90 | $37,564.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,047.21 / $22,240.46 / $46,707.71
| Facility | | $16,047.21 | $22,240.46 | $46,707.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,066.66 / $22,240.46 / $47,310.79
| Facility | | $15,066.66 | $22,240.46 | $47,310.79 |