- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $26,302.68 / $38,904.51
| Facility | | $20,892.96 | $26,302.68 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $19,054.61 / $22,387.21
| Facility | | $15,135.61 | $19,054.61 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $22,908.68 / $42,657.95
| Facility | | $10,232.93 | $22,908.68 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151,356.12 / $151,356.12 / $151,356.12
| Facility | | $151,356.12 | $151,356.12 | $151,356.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $25,118.86 / $46,773.51
| Facility | | $19,054.61 | $25,118.86 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $26,302.68 / $46,773.51
| Facility | | $13,182.57 | $26,302.68 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $23,988.33 / $43,651.58
| Facility | | $15,848.93 | $23,988.33 | $43,651.58 |