- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,104.10 / $20,952.40 / $27,356.30
| Facility | | $10,104.10 | $20,952.40 | $27,356.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,133.80 / $51,236.58
| Facility | | $5,840.42 | $19,133.80 | $51,236.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,838.78 / $19,575.68 / $29,579.09
| Facility | | $11,838.78 | $19,575.68 | $29,579.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,799.48 / $27,799.48 / $27,799.48
| Facility | | $27,799.48 | $27,799.48 | $27,799.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,057.37 / $19,720.74 / $30,453.45
| Facility | | $17,057.37 | $19,720.74 | $30,453.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,133.80 / $51,236.58
| Facility | | $5,840.42 | $19,133.80 | $51,236.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,133.80 / $40,041.83
| Facility | | $5,840.42 | $19,133.80 | $40,041.83 |