- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,122.20 / $20,989.80 / $27,405.10
| Facility | | $10,122.20 | $20,989.80 | $27,405.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,167.99 / $51,328.13
| Facility | | $5,840.42 | $19,167.99 | $51,328.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,859.94 / $19,610.66 / $29,631.95
| Facility | | $11,859.94 | $19,610.66 | $29,631.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,849.16 / $27,849.16 / $27,849.16
| Facility | | $27,849.16 | $27,849.16 | $27,849.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,087.84 / $19,755.98 / $30,507.87
| Facility | | $17,087.84 | $19,755.98 | $30,507.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,167.99 / $51,328.13
| Facility | | $5,840.42 | $19,167.99 | $51,328.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,167.99 / $40,113.39
| Facility | | $5,840.42 | $19,167.99 | $40,113.39 |