- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $16,218.10 / $26,302.68
| Facility | | $10,964.78 | $16,218.10 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $11,481.54 / $19,498.45
| Facility | | $5,623.41 | $11,481.54 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $17,782.79 / $31,622.78
| Facility | | $10,232.93 | $17,782.79 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $40,738.03
| Facility | | $40,738.03 | $40,738.03 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $14,791.08 / $26,302.68
| Facility | | $6,309.57 | $14,791.08 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $14,791.08 / $33,884.42
| Facility | | $10,232.93 | $14,791.08 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $13,803.84 / $30,902.95
| Facility | | $5,248.07 | $13,803.84 | $30,902.95 |