- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,383.80 / $23,605.90 / $30,820.90
| Facility | | $11,383.80 | $23,605.90 | $30,820.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,278.62 / $57,725.55
| Facility | | $5,840.42 | $21,278.62 | $57,725.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,338.13 / $22,054.89 / $33,325.19
| Facility | | $13,338.13 | $22,054.89 | $33,325.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,320.21 / $31,320.21 / $31,320.21
| Facility | | $31,320.21 | $31,320.21 | $31,320.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,217.64 / $22,218.32 / $34,310.30
| Facility | | $19,217.64 | $22,218.32 | $34,310.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,278.62 / $57,725.55
| Facility | | $5,840.42 | $21,278.62 | $57,725.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,764.74 / $45,113.03
| Facility | | $5,840.42 | $16,764.74 | $45,113.03 |