- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $26,302.68 / $50,118.72
| Facility | | $14,791.08 | $26,302.68 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $28,840.32 / $47,863.01
| Facility | | $16,218.10 | $28,840.32 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $18,197.01 / $40,738.03
| Facility | | $100.00 | $18,197.01 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $23,442.29 / $40,738.03
| Facility | | $15,488.17 | $23,442.29 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $40,738.03
| Facility | | $40,738.03 | $40,738.03 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $25,703.96 / $45,708.82
| Facility | | $15,848.93 | $25,703.96 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $22,387.21 / $45,708.82
| Facility | | $5,754.40 | $22,387.21 | $45,708.82 |