- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,279.40 / $21,315.80 / $27,830.80
| Facility | | $10,279.40 | $21,315.80 | $27,830.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,465.73 / $52,125.43
| Facility | | $5,840.42 | $19,465.73 | $52,125.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,044.16 / $19,915.28 / $30,092.23
| Facility | | $12,044.16 | $19,915.28 | $30,092.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,281.75 / $28,281.75 / $28,281.75
| Facility | | $28,281.75 | $28,281.75 | $28,281.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,353.28 / $20,062.84 / $30,981.75
| Facility | | $17,353.28 | $20,062.84 | $30,981.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,465.73 / $52,125.43
| Facility | | $5,840.42 | $19,465.73 | $52,125.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,465.73 / $40,736.48
| Facility | | $5,840.42 | $19,465.73 | $40,736.48 |