- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,528.40 / $21,832.20 / $28,505.00
| Facility | | $10,528.40 | $21,832.20 | $28,505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,937.28 / $53,388.13
| Facility | | $5,840.42 | $19,937.28 | $53,388.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,335.92 / $20,397.71 / $30,821.19
| Facility | | $12,335.92 | $20,397.71 | $30,821.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,966.85 / $28,966.85 / $28,966.85
| Facility | | $28,966.85 | $28,966.85 | $28,966.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,773.65 / $20,548.86 / $31,732.26
| Facility | | $17,773.65 | $20,548.86 | $31,732.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,937.28 / $53,388.13
| Facility | | $5,840.42 | $19,937.28 | $53,388.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,937.28 / $41,723.29
| Facility | | $5,840.42 | $19,937.28 | $41,723.29 |