- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,005.22 / $16,600.00 / $21,673.60
| Facility | | $8,005.22 | $16,600.00 | $21,673.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,963.37 / $40,593.29
| Facility | | $5,840.42 | $14,963.37 | $40,593.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,379.53 / $15,509.26 / $23,434.67
| Facility | | $9,379.53 | $15,509.26 | $23,434.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,024.74 / $22,024.74 / $22,024.74
| Facility | | $22,024.74 | $22,024.74 | $22,024.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,514.07 / $15,624.18 / $24,127.40
| Facility | | $13,514.07 | $15,624.18 | $24,127.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,963.37 / $40,593.29
| Facility | | $5,840.42 | $14,963.37 | $40,593.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,789.16 / $31,724.01
| Facility | | $5,840.42 | $11,789.16 | $31,724.01 |