- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,425.40 / $29,913.00 / $39,055.60
| Facility | | $14,425.40 | $29,913.00 | $39,055.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $26,963.89 / $73,148.78
| Facility | | $5,840.42 | $26,963.89 | $73,148.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,901.84 / $27,947.56 / $42,229.10
| Facility | | $16,901.84 | $27,947.56 | $42,229.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,688.42 / $39,688.42 / $39,688.42
| Facility | | $39,688.42 | $39,688.42 | $39,688.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,352.25 / $28,154.65 / $43,477.40
| Facility | | $24,352.25 | $28,154.65 | $43,477.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $26,963.89 / $73,148.78
| Facility | | $5,840.42 | $26,963.89 | $73,148.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,243.98 / $57,166.43
| Facility | | $5,840.42 | $21,243.98 | $57,166.43 |