- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,761.60 / $30,610.30 / $39,966.10
| Facility | | $14,761.60 | $30,610.30 | $39,966.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $27,592.46 / $74,854.00
| Facility | | $5,840.42 | $27,592.46 | $74,854.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,295.84 / $28,599.07 / $43,213.53
| Facility | | $17,295.84 | $28,599.07 | $43,213.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,613.62 / $40,613.62 / $40,613.62
| Facility | | $40,613.62 | $40,613.62 | $40,613.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,919.94 / $28,810.98 / $44,490.92
| Facility | | $24,919.94 | $28,810.98 | $44,490.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $27,592.46 / $74,854.00
| Facility | | $5,840.42 | $27,592.46 | $74,854.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,739.21 / $58,499.07
| Facility | | $5,840.42 | $21,739.21 | $58,499.07 |