- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,541.80 / $23,933.50 / $31,248.60
| Facility | | $11,541.80 | $23,933.50 | $31,248.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,856.21 / $58,526.66
| Facility | | $5,840.42 | $21,856.21 | $58,526.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,523.24 / $22,360.97 / $33,787.69
| Facility | | $13,523.24 | $22,360.97 | $33,787.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,754.87 / $31,754.87 / $31,754.87
| Facility | | $31,754.87 | $31,754.87 | $31,754.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,484.34 / $22,526.66 / $34,786.44
| Facility | | $19,484.34 | $22,526.66 | $34,786.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,856.21 / $58,526.66
| Facility | | $5,840.42 | $21,856.21 | $58,526.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,856.21 / $45,739.10
| Facility | | $5,840.42 | $21,856.21 | $45,739.10 |