- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,611.58 / $17,857.30 / $23,315.30
| Facility | | $8,611.58 | $17,857.30 | $23,315.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,096.77 / $43,668.02
| Facility | | $5,840.42 | $16,096.77 | $43,668.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,089.98 / $16,684.00 / $25,209.73
| Facility | | $10,089.98 | $16,684.00 | $25,209.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,693.00 / $23,693.00 / $23,693.00
| Facility | | $23,693.00 | $23,693.00 | $23,693.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,537.69 / $16,807.63 / $25,954.93
| Facility | | $14,537.69 | $16,807.63 | $25,954.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,096.77 / $43,668.02
| Facility | | $5,840.42 | $16,096.77 | $43,668.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,307.40 / $34,126.94
| Facility | | $5,840.42 | $16,307.40 | $34,126.94 |