- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,807.90 / $25,426.40 / $33,197.80
| Facility | | $10,807.90 | $25,426.40 | $33,197.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,322.00 / $62,177.43
| Facility | | $5,840.42 | $23,322.00 | $62,177.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,366.79 / $23,755.79 / $35,895.29
| Facility | | $14,366.79 | $23,755.79 | $35,895.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,735.67 / $33,735.67 / $33,735.67
| Facility | | $33,735.67 | $33,735.67 | $33,735.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,699.73 / $23,931.82 / $36,956.35
| Facility | | $20,699.73 | $23,931.82 | $36,956.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,322.00 / $62,177.43
| Facility | | $5,840.42 | $23,322.00 | $62,177.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,219.56 / $48,592.21
| Facility | | $5,840.42 | $23,219.56 | $48,592.21 |