- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,486.90 / $23,819.60 / $31,099.90
| Facility | | $11,486.90 | $23,819.60 | $31,099.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,471.27 / $58,248.18
| Facility | | $5,840.42 | $21,471.27 | $58,248.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,458.89 / $22,254.57 / $33,626.92
| Facility | | $13,458.89 | $22,254.57 | $33,626.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,603.78 / $31,603.78 / $31,603.78
| Facility | | $31,603.78 | $31,603.78 | $31,603.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,391.63 / $22,419.47 / $34,620.93
| Facility | | $19,391.63 | $22,419.47 | $34,620.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,471.27 / $58,248.18
| Facility | | $5,840.42 | $21,471.27 | $58,248.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,916.53 / $45,521.47
| Facility | | $5,840.42 | $16,916.53 | $45,521.47 |