- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,669.90 / $22,125.50 / $28,887.90
| Facility | | $10,669.90 | $22,125.50 | $28,887.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,205.09 / $54,105.31
| Facility | | $5,840.42 | $20,205.09 | $54,105.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,501.63 / $20,671.72 / $31,235.22
| Facility | | $12,501.63 | $20,671.72 | $31,235.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,355.97 / $29,355.97 / $29,355.97
| Facility | | $29,355.97 | $29,355.97 | $29,355.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,012.41 / $20,824.90 / $32,158.53
| Facility | | $18,012.41 | $20,824.90 | $32,158.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,205.09 / $54,105.31
| Facility | | $5,840.42 | $20,205.09 | $54,105.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,205.09 / $42,283.78
| Facility | | $5,840.42 | $20,205.09 | $42,283.78 |