- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,604.81 / $17,843.30 / $23,296.90
| Facility | | $8,604.81 | $17,843.30 | $23,296.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,084.12 / $43,633.68
| Facility | | $5,840.42 | $16,084.12 | $43,633.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,082.04 / $16,670.89 / $25,189.91
| Facility | | $10,082.04 | $16,670.89 | $25,189.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,674.37 / $23,674.37 / $23,674.37
| Facility | | $23,674.37 | $23,674.37 | $23,674.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,526.26 / $16,794.41 / $25,934.52
| Facility | | $14,526.26 | $16,794.41 | $25,934.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,084.12 / $43,633.68
| Facility | | $5,840.42 | $16,084.12 | $43,633.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,672.16 / $34,100.11
| Facility | | $5,840.42 | $12,672.16 | $34,100.11 |