- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $14,454.40 / $23,442.29
| Facility | | $10,471.29 | $14,454.40 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $10,232.93 / $17,782.79
| Facility | | $5,128.61 | $10,232.93 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $15,488.17 / $27,542.29
| Facility | | $9,120.11 | $15,488.17 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,307.81 / $36,307.81 / $36,307.81
| Facility | | $36,307.81 | $36,307.81 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $14,454.40 / $23,442.29
| Facility | | $5,623.41 | $14,454.40 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $13,182.57 / $30,199.52
| Facility | | $9,120.11 | $13,182.57 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $12,302.69 / $27,542.29
| Facility | | $4,897.79 | $12,302.69 | $27,542.29 |