- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,526.90 / $21,829.10 / $28,500.90
| Facility | | $10,526.90 | $21,829.10 | $28,500.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,934.43 / $53,380.50
| Facility | | $5,840.42 | $19,934.43 | $53,380.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,334.16 / $20,394.80 / $30,816.78
| Facility | | $12,334.16 | $20,394.80 | $30,816.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,962.71 / $28,962.71 / $28,962.71
| Facility | | $28,962.71 | $28,962.71 | $28,962.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,771.11 / $20,545.91 / $31,727.73
| Facility | | $17,771.11 | $20,545.91 | $31,727.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,934.43 / $53,380.50
| Facility | | $5,840.42 | $19,934.43 | $53,380.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,934.43 / $41,717.33
| Facility | | $5,840.42 | $19,934.43 | $41,717.33 |