- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $30,902.95 / $42,657.95
| Facility | | $16,595.87 | $30,902.95 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Facility | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $23,988.33 / $38,018.94
| Facility | | $16,595.87 | $23,988.33 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $31,622.78 / $45,708.82
| Facility | | $16,218.10 | $31,622.78 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $23,988.33 / $50,118.72
| Facility | | $7,079.46 | $23,988.33 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $23,988.33 / $47,863.01
| Facility | | $6,456.54 | $23,988.33 | $47,863.01 |