- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,862.50 / $22,524.80 / $29,409.40
| Facility | | $10,862.50 | $22,524.80 | $29,409.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,304.12 / $55,081.90
| Facility | | $5,840.42 | $20,304.12 | $55,081.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,727.29 / $21,044.84 / $31,799.01
| Facility | | $12,727.29 | $21,044.84 | $31,799.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,885.84 / $29,885.84 / $29,885.84
| Facility | | $29,885.84 | $29,885.84 | $29,885.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,337.53 / $21,200.78 / $32,738.99
| Facility | | $18,337.53 | $21,200.78 | $32,738.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,304.12 / $55,081.90
| Facility | | $5,840.42 | $20,304.12 | $55,081.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $20,304.12 / $47,940.37
| Facility | | $3,775.00 | $20,304.12 | $47,940.37 |