- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,570.20 / $26,066.00 / $34,032.90
| Facility | | $12,570.20 | $26,066.00 | $34,032.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,496.20 / $63,741.49
| Facility | | $5,840.42 | $23,496.20 | $63,741.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,728.18 / $24,353.37 / $36,798.23
| Facility | | $14,728.18 | $24,353.37 | $36,798.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,584.29 / $34,584.29 / $34,584.29
| Facility | | $34,584.29 | $34,584.29 | $34,584.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,220.43 / $24,533.82 / $37,885.99
| Facility | | $21,220.43 | $24,533.82 | $37,885.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,496.20 / $63,741.49
| Facility | | $5,840.42 | $23,496.20 | $63,741.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,511.90 / $49,814.54
| Facility | | $5,840.42 | $18,511.90 | $49,814.54 |