- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,169.60 / $21,088.10 / $27,533.50
| Facility | | $10,169.60 | $21,088.10 | $27,533.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,009.00 / $51,568.47
| Facility | | $5,840.42 | $19,009.00 | $51,568.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,915.47 / $19,702.49 / $29,770.69
| Facility | | $11,915.47 | $19,702.49 | $29,770.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,979.56 / $27,979.56 / $27,979.56
| Facility | | $27,979.56 | $27,979.56 | $27,979.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,167.86 / $19,848.48 / $30,650.71
| Facility | | $17,167.86 | $19,848.48 | $30,650.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,009.00 / $51,568.47
| Facility | | $5,840.42 | $19,009.00 | $51,568.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,976.59 / $40,301.21
| Facility | | $5,840.42 | $14,976.59 | $40,301.21 |