- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,155.90 / $23,133.20 / $30,203.70
| Facility | | $11,155.90 | $23,133.20 | $30,203.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,852.54 / $56,569.67
| Facility | | $5,840.42 | $20,852.54 | $56,569.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,071.05 / $21,613.27 / $32,657.91
| Facility | | $13,071.05 | $21,613.27 | $32,657.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,693.06 / $30,693.06 / $30,693.06
| Facility | | $30,693.06 | $30,693.06 | $30,693.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,832.83 / $21,773.42 / $33,623.26
| Facility | | $18,832.83 | $21,773.42 | $33,623.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,852.54 / $56,569.67
| Facility | | $5,840.42 | $20,852.54 | $56,569.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,429.05 / $44,209.70
| Facility | | $5,840.42 | $16,429.05 | $44,209.70 |