- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,516.40 / $21,807.20 / $28,472.40
| Facility | | $10,516.40 | $21,807.20 | $28,472.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,914.48 / $53,327.09
| Facility | | $5,840.42 | $19,914.48 | $53,327.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,321.82 / $20,374.39 / $30,785.95
| Facility | | $12,321.82 | $20,374.39 | $30,785.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,933.73 / $28,933.73 / $28,933.73
| Facility | | $28,933.73 | $28,933.73 | $28,933.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,753.33 / $20,525.37 / $31,695.98
| Facility | | $17,753.33 | $20,525.37 | $31,695.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,914.48 / $53,327.09
| Facility | | $5,840.42 | $19,914.48 | $53,327.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,914.48 / $41,675.58
| Facility | | $5,840.42 | $19,914.48 | $41,675.58 |