- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,762.60 / $20,244.09 / $26,431.60
| Facility | | $9,762.60 | $20,244.09 | $26,431.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,248.25 / $49,504.66
| Facility | | $5,840.42 | $18,248.25 | $49,504.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,438.60 / $18,913.98 / $28,579.25
| Facility | | $11,438.60 | $18,913.98 | $28,579.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,236.78 / $26,236.78 / $26,236.78
| Facility | | $26,236.78 | $26,236.78 | $26,236.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,480.79 / $19,054.13 / $29,424.05
| Facility | | $16,480.79 | $19,054.13 | $29,424.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,248.25 / $49,504.66
| Facility | | $5,840.42 | $18,248.25 | $49,504.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,377.22 / $38,688.33
| Facility | | $5,840.42 | $14,377.22 | $38,688.33 |