- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,725.90 / $26,389.00 / $34,454.50
| Facility | | $12,725.90 | $26,389.00 | $34,454.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,098.53 / $64,531.16
| Facility | | $5,840.42 | $24,098.53 | $64,531.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,910.64 / $24,655.07 / $37,254.11
| Facility | | $14,910.64 | $24,655.07 | $37,254.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,012.74 / $35,012.74 / $35,012.74
| Facility | | $35,012.74 | $35,012.74 | $35,012.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,483.32 / $24,837.76 / $38,355.33
| Facility | | $21,483.32 | $24,837.76 | $38,355.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,098.53 / $64,531.16
| Facility | | $5,840.42 | $24,098.53 | $64,531.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,098.53 / $50,431.67
| Facility | | $5,840.42 | $24,098.53 | $50,431.67 |