- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,846.10 / $20,417.30 / $26,657.60
| Facility | | $9,846.10 | $20,417.30 | $26,657.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,645.16 / $49,928.10
| Facility | | $5,840.42 | $18,645.16 | $49,928.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,536.44 / $19,075.75 / $28,823.70
| Facility | | $11,536.44 | $19,075.75 | $28,823.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,089.54 / $27,089.54 / $27,089.54
| Facility | | $27,089.54 | $27,089.54 | $27,089.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,621.75 / $19,217.11 / $29,675.73
| Facility | | $16,621.75 | $19,217.11 | $29,675.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,645.16 / $49,928.10
| Facility | | $5,840.42 | $18,645.16 | $49,928.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,645.16 / $39,019.25
| Facility | | $5,840.42 | $18,645.16 | $39,019.25 |