- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,611.60 / $24,964.70 / $34,762.00
| Facility | | $10,611.60 | $24,964.70 | $34,762.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $22,797.87 / $61,048.24
| Facility | | $5,840.42 | $22,797.87 | $61,048.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,105.88 / $23,157.94 / $35,243.41
| Facility | | $14,105.88 | $23,157.94 | $35,243.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,123.01 / $33,123.01 / $33,123.01
| Facility | | $33,123.01 | $33,123.01 | $33,123.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,323.81 / $23,497.20 / $36,285.19
| Facility | | $20,323.81 | $23,497.20 | $36,285.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $22,797.87 / $61,048.24
| Facility | | $5,840.42 | $22,797.87 | $61,048.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,119.53 / $53,133.16
| Facility | | $5,840.42 | $23,119.53 | $53,133.16 |