- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $19,498.45 / $39,810.72
| Facility | | $8,709.64 | $19,498.45 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $33,884.42 / $41,686.94
| Facility | | $22,387.21 | $33,884.42 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $24,547.09 / $33,884.42
| Facility | | $15,488.17 | $24,547.09 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $25,118.86 / $64,565.42
| Facility | | $14,125.38 | $25,118.86 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $17,378.01 / $33,884.42
| Facility | | $7,413.10 | $17,378.01 | $33,884.42 |