- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,145.00 / $23,314.20 / $36,847.00
| Facility | | $4,145.00 | $23,314.20 | $36,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,290.65 / $62,528.39
| Facility | | $5,840.42 | $21,290.65 | $62,528.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,709.90 / $21,782.34 / $31,347.14
| Facility | | $12,709.90 | $21,782.34 | $31,347.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,933.16 / $30,933.16 / $30,933.16
| Facility | | $30,933.16 | $30,933.16 | $30,933.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,980.15 / $21,943.74 / $33,886.29
| Facility | | $18,980.15 | $21,943.74 | $33,886.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,290.65 / $62,528.39
| Facility | | $5,840.42 | $21,290.65 | $62,528.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,290.65 / $44,555.53
| Facility | | $5,840.42 | $21,290.65 | $44,555.53 |