- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,178.60 / $21,106.80 / $27,557.90
| Facility | | $10,178.60 | $21,106.80 | $27,557.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,274.84 / $51,614.24
| Facility | | $5,840.42 | $19,274.84 | $51,614.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,926.05 / $19,719.98 / $29,797.12
| Facility | | $11,926.05 | $19,719.98 | $29,797.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,004.39 / $28,004.39 / $28,004.39
| Facility | | $28,004.39 | $28,004.39 | $28,004.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,183.09 / $19,866.09 / $30,677.92
| Facility | | $17,183.09 | $19,866.09 | $30,677.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,274.84 / $51,614.24
| Facility | | $5,840.42 | $19,274.84 | $51,614.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,274.84 / $40,336.99
| Facility | | $5,840.42 | $19,274.84 | $40,336.99 |