- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,071.20 / $27,105.00 / $35,389.40
| Facility | | $13,071.20 | $27,105.00 | $35,389.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,752.43 / $66,282.14
| Facility | | $5,840.42 | $24,752.43 | $66,282.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,315.23 / $25,324.06 / $38,264.96
| Facility | | $15,315.23 | $25,324.06 | $38,264.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,962.78 / $35,962.78 / $35,962.78
| Facility | | $35,962.78 | $35,962.78 | $35,962.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,066.25 / $25,511.71 / $39,396.08
| Facility | | $22,066.25 | $25,511.71 | $39,396.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,752.43 / $66,282.14
| Facility | | $5,840.42 | $24,752.43 | $66,282.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,752.43 / $51,800.09
| Facility | | $5,840.42 | $24,752.43 | $51,800.09 |