- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,785.36 / $18,217.70 / $23,785.80
| Facility | | $8,785.36 | $18,217.70 | $23,785.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,636.48 / $44,549.23
| Facility | | $5,840.42 | $16,636.48 | $44,549.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,293.60 / $17,020.68 / $25,718.46
| Facility | | $10,293.60 | $17,020.68 | $25,718.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,171.12 / $24,171.12 / $24,171.12
| Facility | | $24,171.12 | $24,171.12 | $24,171.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,831.06 / $17,146.81 / $26,478.70
| Facility | | $14,831.06 | $17,146.81 | $26,478.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,636.48 / $44,549.23
| Facility | | $5,840.42 | $16,636.48 | $44,549.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,636.48 / $34,815.62
| Facility | | $5,840.42 | $16,636.48 | $34,815.62 |