- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,233.30 / $23,293.90 / $30,413.50
| Facility | | $11,233.30 | $23,293.90 | $30,413.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,272.13 / $56,962.59
| Facility | | $5,840.42 | $21,272.13 | $56,962.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,161.84 / $21,763.39 / $32,884.74
| Facility | | $13,161.84 | $21,763.39 | $32,884.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,906.25 / $30,906.25 / $30,906.25
| Facility | | $30,906.25 | $30,906.25 | $30,906.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,963.64 / $21,924.66 / $33,856.82
| Facility | | $18,963.64 | $21,924.66 | $33,856.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,272.13 / $56,962.59
| Facility | | $5,840.42 | $21,272.13 | $56,962.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,272.13 / $44,516.77
| Facility | | $5,840.42 | $21,272.13 | $44,516.77 |