- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,529.80 / $23,908.60 / $31,216.00
| Facility | | $11,529.80 | $23,908.60 | $31,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,551.42 / $58,465.62
| Facility | | $5,840.42 | $21,551.42 | $58,465.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,509.13 / $22,337.65 / $33,752.44
| Facility | | $13,509.13 | $22,337.65 | $33,752.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,721.75 / $31,721.75 / $31,721.75
| Facility | | $31,721.75 | $31,721.75 | $31,721.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,464.02 / $22,503.17 / $34,750.17
| Facility | | $19,464.02 | $22,503.17 | $34,750.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,551.42 / $58,465.62
| Facility | | $5,840.42 | $21,551.42 | $58,465.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,979.68 / $45,691.40
| Facility | | $5,840.42 | $16,979.68 | $45,691.40 |