- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,216.62 / $17,038.30 / $22,245.90
| Facility | | $8,216.62 | $17,038.30 | $22,245.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,559.48 / $48,537.00
| Facility | | $5,840.42 | $15,559.48 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,627.21 / $15,918.82 / $24,053.52
| Facility | | $9,627.21 | $15,918.82 | $24,053.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,606.36 / $22,606.36 / $22,606.36
| Facility | | $22,606.36 | $22,606.36 | $22,606.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,870.94 / $16,036.77 / $24,764.54
| Facility | | $13,870.94 | $16,036.77 | $24,764.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,559.48 / $48,537.00
| Facility | | $5,840.42 | $15,559.48 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,559.48 / $32,561.76
| Facility | | $5,840.42 | $15,559.48 | $32,561.76 |