- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,141.60 / $23,103.60 / $30,165.00
| Facility | | $11,141.60 | $23,103.60 | $30,165.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,825.82 / $56,497.19
| Facility | | $5,840.42 | $20,825.82 | $56,497.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,054.30 / $21,585.58 / $32,616.06
| Facility | | $13,054.30 | $21,585.58 | $32,616.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,653.74 / $30,653.74 / $30,653.74
| Facility | | $30,653.74 | $30,653.74 | $30,653.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,808.70 / $21,745.52 / $33,580.19
| Facility | | $18,808.70 | $21,745.52 | $33,580.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,825.82 / $56,497.19
| Facility | | $5,840.42 | $20,825.82 | $56,497.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,408.00 / $44,153.05
| Facility | | $5,840.42 | $16,408.00 | $44,153.05 |