- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,044.90 / $18,755.90 / $24,488.40
| Facility | | $9,044.90 | $18,755.90 | $24,488.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $17,127.97 / $45,865.34
| Facility | | $5,840.42 | $17,127.97 | $45,865.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,597.70 / $17,523.52 / $26,478.25
| Facility | | $10,597.70 | $17,523.52 | $26,478.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,885.21 / $24,885.21 / $24,885.21
| Facility | | $24,885.21 | $24,885.21 | $24,885.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,269.21 / $17,653.37 / $27,260.95
| Facility | | $15,269.21 | $17,653.37 | $27,260.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $17,127.97 / $45,865.34
| Facility | | $5,840.42 | $17,127.97 | $45,865.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $17,127.97 / $35,844.17
| Facility | | $5,840.42 | $17,127.97 | $35,844.17 |