- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,125.20 / $20,996.00 / $27,413.30
| Facility | | $10,125.20 | $20,996.00 | $27,413.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,173.68 / $51,343.39
| Facility | | $5,840.42 | $19,173.68 | $51,343.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,863.46 / $19,616.49 / $29,640.76
| Facility | | $11,863.46 | $19,616.49 | $29,640.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,857.44 / $27,857.44 / $27,857.44
| Facility | | $27,857.44 | $27,857.44 | $27,857.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,092.93 / $19,761.84 / $30,516.94
| Facility | | $17,092.93 | $19,761.84 | $30,516.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,173.68 / $51,343.39
| Facility | | $5,840.42 | $19,173.68 | $51,343.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,173.68 / $40,125.32
| Facility | | $5,840.42 | $19,173.68 | $40,125.32 |