- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,069.10 / $25,027.10 / $32,676.40
| Facility | | $12,069.10 | $25,027.10 | $32,676.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $22,559.67 / $61,200.84
| Facility | | $5,840.42 | $22,559.67 | $61,200.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,141.13 / $23,382.67 / $35,331.50
| Facility | | $14,141.13 | $23,382.67 | $35,331.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,205.80 / $33,205.80 / $33,205.80
| Facility | | $33,205.80 | $33,205.80 | $33,205.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,374.61 / $23,555.94 / $36,375.90
| Facility | | $20,374.61 | $23,555.94 | $36,375.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $22,559.67 / $61,200.84
| Facility | | $5,840.42 | $22,559.67 | $61,200.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $17,774.04 / $47,829.00
| Facility | | $5,840.42 | $17,774.04 | $47,829.00 |