- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,074.60 / $22,964.80 / $29,983.70
| Facility | | $11,074.60 | $22,964.80 | $29,983.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,700.66 / $56,157.67
| Facility | | $5,840.42 | $20,700.66 | $56,157.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,975.85 / $21,455.86 / $32,420.06
| Facility | | $12,975.85 | $21,455.86 | $32,420.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,469.53 / $30,469.53 / $30,469.53
| Facility | | $30,469.53 | $30,469.53 | $30,469.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,695.66 / $21,614.84 / $33,378.40
| Facility | | $18,695.66 | $21,614.84 | $33,378.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,700.66 / $56,157.67
| Facility | | $5,840.42 | $20,700.66 | $56,157.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,309.40 / $43,887.72
| Facility | | $5,840.42 | $16,309.40 | $43,887.72 |