- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,002.20 / $23,531.00 / $34,762.00
| Facility | | $10,002.20 | $23,531.00 | $34,762.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,488.67 / $57,542.44
| Facility | | $5,840.42 | $21,488.67 | $57,542.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,295.82 / $21,973.25 / $33,219.49
| Facility | | $13,295.82 | $21,973.25 | $33,219.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,220.86 / $31,220.86 / $31,220.86
| Facility | | $31,220.86 | $31,220.86 | $31,220.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,156.68 / $22,147.84 / $34,201.46
| Facility | | $19,156.68 | $22,147.84 | $34,201.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,488.67 / $57,542.44
| Facility | | $5,840.42 | $21,488.67 | $57,542.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,791.85 / $50,081.90
| Facility | | $5,840.42 | $21,791.85 | $50,081.90 |