- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,185.90 / $23,195.60 / $30,285.20
| Facility | | $11,185.90 | $23,195.60 | $30,285.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,908.79 / $56,722.26
| Facility | | $5,840.42 | $20,908.79 | $56,722.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,106.31 / $21,671.57 / $32,746.00
| Facility | | $13,106.31 | $21,671.57 | $32,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,775.86 / $30,775.86 / $30,775.86
| Facility | | $30,775.86 | $30,775.86 | $30,775.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,883.63 / $21,832.15 / $33,713.97
| Facility | | $18,883.63 | $21,832.15 | $33,713.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,908.79 / $56,722.26
| Facility | | $5,840.42 | $20,908.79 | $56,722.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,473.37 / $44,328.95
| Facility | | $5,840.42 | $16,473.37 | $44,328.95 |