- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,333.60 / $21,428.20 / $27,977.50
| Facility | | $10,333.60 | $21,428.20 | $27,977.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,315.56 / $52,400.09
| Facility | | $5,840.42 | $19,315.56 | $52,400.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,107.62 / $20,020.22 / $30,250.79
| Facility | | $12,107.62 | $20,020.22 | $30,250.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,430.77 / $28,430.77 / $28,430.77
| Facility | | $28,430.77 | $28,430.77 | $28,430.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,444.72 / $20,168.57 / $31,145.01
| Facility | | $17,444.72 | $20,168.57 | $31,145.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,315.56 / $52,400.09
| Facility | | $5,840.42 | $19,315.56 | $52,400.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,218.11 / $40,951.14
| Facility | | $5,840.42 | $15,218.11 | $40,951.14 |