- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,728.60 / $22,247.20 / $29,046.80
| Facility | | $10,728.60 | $22,247.20 | $29,046.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,316.22 / $54,402.86
| Facility | | $5,840.42 | $20,316.22 | $54,402.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,570.39 / $20,785.41 / $31,407.00
| Facility | | $12,570.39 | $20,785.41 | $31,407.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,517.42 / $29,517.42 / $29,517.42
| Facility | | $29,517.42 | $29,517.42 | $29,517.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,111.47 / $20,939.43 / $32,335.39
| Facility | | $18,111.47 | $20,939.43 | $32,335.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,316.22 / $54,402.86
| Facility | | $5,840.42 | $20,316.22 | $54,402.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,316.22 / $42,516.32
| Facility | | $5,840.42 | $20,316.22 | $42,516.32 |