- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,016.90 / $20,771.40 / $27,120.00
| Facility | | $10,016.90 | $20,771.40 | $27,120.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,723.55 / $50,794.06
| Facility | | $5,840.42 | $18,723.55 | $50,794.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,736.53 / $19,406.61 / $29,323.62
| Facility | | $11,736.53 | $19,406.61 | $29,323.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,559.39 / $27,559.39 / $27,559.39
| Facility | | $27,559.39 | $27,559.39 | $27,559.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,910.05 / $19,550.41 / $30,190.43
| Facility | | $16,910.05 | $19,550.41 | $30,190.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,723.55 / $50,794.06
| Facility | | $5,840.42 | $18,723.55 | $50,794.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,751.69 / $39,696.01
| Facility | | $5,840.42 | $14,751.69 | $39,696.01 |