- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,256.10 / $21,267.50 / $27,767.70
| Facility | | $10,256.10 | $21,267.50 | $27,767.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,421.57 / $52,007.17
| Facility | | $5,840.42 | $19,421.57 | $52,007.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,016.84 / $19,870.09 / $30,023.96
| Facility | | $12,016.84 | $19,870.09 | $30,023.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,217.58 / $28,217.58 / $28,217.58
| Facility | | $28,217.58 | $28,217.58 | $28,217.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,313.91 / $20,017.33 / $30,911.46
| Facility | | $17,313.91 | $20,017.33 | $30,911.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,421.57 / $52,007.17
| Facility | | $5,840.42 | $19,421.57 | $52,007.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,421.57 / $40,644.06
| Facility | | $5,840.42 | $19,421.57 | $40,644.06 |