- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,541.20 / $21,858.70 / $28,539.60
| Facility | | $10,541.20 | $21,858.70 | $28,539.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,961.50 / $53,452.98
| Facility | | $5,840.42 | $19,961.50 | $53,452.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,350.91 / $20,422.49 / $30,858.63
| Facility | | $12,350.91 | $20,422.49 | $30,858.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,002.04 / $29,002.04 / $29,002.04
| Facility | | $29,002.04 | $29,002.04 | $29,002.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,795.24 / $20,573.82 / $31,770.81
| Facility | | $17,795.24 | $20,573.82 | $31,770.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,961.50 / $53,452.98
| Facility | | $5,840.42 | $19,961.50 | $53,452.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,961.50 / $41,773.98
| Facility | | $5,840.42 | $19,961.50 | $41,773.98 |