- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,067.60 / $25,024.00 / $32,672.30
| Facility | | $12,067.60 | $25,024.00 | $32,672.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $22,852.01 / $61,193.21
| Facility | | $5,840.42 | $22,852.01 | $61,193.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,595.55 / $23,212.93 / $35,327.08
| Facility | | $13,595.55 | $23,212.93 | $35,327.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,201.66 / $33,201.66 / $33,201.66
| Facility | | $33,201.66 | $33,201.66 | $33,201.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,372.07 / $23,553.00 / $36,371.36
| Facility | | $20,372.07 | $23,553.00 | $36,371.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $22,852.01 / $61,193.21
| Facility | | $5,840.42 | $22,852.01 | $61,193.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $17,771.82 / $47,823.03
| Facility | | $5,840.42 | $17,771.82 | $47,823.03 |