- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,762.20 / $24,390.60 / $31,845.40
| Facility | | $11,762.20 | $24,390.60 | $31,845.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,985.94 / $59,644.40
| Facility | | $5,840.42 | $21,985.94 | $59,644.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,781.50 / $22,788.01 / $34,432.96
| Facility | | $13,781.50 | $22,788.01 | $34,432.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,361.32 / $32,361.32 / $32,361.32
| Facility | | $32,361.32 | $32,361.32 | $32,361.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,856.45 / $22,956.87 / $35,450.80
| Facility | | $19,856.45 | $22,956.87 | $35,450.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,985.94 / $59,644.40
| Facility | | $5,840.42 | $21,985.94 | $59,644.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $17,322.02 / $46,612.63
| Facility | | $5,840.42 | $17,322.02 | $46,612.63 |