- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,750.20 / $24,365.60 / $31,812.80
| Facility | | $11,750.20 | $24,365.60 | $31,812.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,963.44 / $59,583.36
| Facility | | $5,840.42 | $21,963.44 | $59,583.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,767.40 / $22,764.69 / $34,397.72
| Facility | | $13,767.40 | $22,764.69 | $34,397.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,328.21 / $32,328.21 / $32,328.21
| Facility | | $32,328.21 | $32,328.21 | $32,328.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,836.13 / $22,933.38 / $35,414.51
| Facility | | $19,836.13 | $22,933.38 | $35,414.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,963.44 / $59,583.36
| Facility | | $5,840.42 | $21,963.44 | $59,583.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $17,304.29 / $46,564.92
| Facility | | $5,840.42 | $17,304.29 | $46,564.92 |