- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,752.07 / $20,222.30 / $26,403.00
| Facility | | $9,752.07 | $20,222.30 | $26,403.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,228.57 / $49,451.25
| Facility | | $5,840.42 | $18,228.57 | $49,451.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,426.26 / $18,893.57 / $28,548.41
| Facility | | $11,426.26 | $18,893.57 | $28,548.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,830.82 / $26,830.82 / $26,830.82
| Facility | | $26,830.82 | $26,830.82 | $26,830.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,463.00 / $19,033.57 / $29,392.31
| Facility | | $16,463.00 | $19,033.57 | $29,392.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,228.57 / $49,451.25
| Facility | | $5,840.42 | $18,228.57 | $49,451.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,361.71 / $38,646.58
| Facility | | $5,840.42 | $14,361.71 | $38,646.58 |