- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,387.00 / $21,538.90 / $28,122.10
| Facility | | $10,387.00 | $21,538.90 | $28,122.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,415.40 / $52,670.94
| Facility | | $5,840.42 | $19,415.40 | $52,670.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,170.21 / $20,123.70 / $30,407.16
| Facility | | $12,170.21 | $20,123.70 | $30,407.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,577.73 / $28,577.73 / $28,577.73
| Facility | | $28,577.73 | $28,577.73 | $28,577.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,534.89 / $20,272.82 / $31,305.99
| Facility | | $17,534.89 | $20,272.82 | $31,305.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,415.40 / $52,670.94
| Facility | | $5,840.42 | $19,415.40 | $52,670.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,296.78 / $41,162.81
| Facility | | $5,840.42 | $15,296.78 | $41,162.81 |