- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,285.60 / $27,549.60 / $35,969.90
| Facility | | $13,285.60 | $27,549.60 | $35,969.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,833.49 / $67,369.37
| Facility | | $5,840.42 | $24,833.49 | $67,369.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,566.44 / $25,739.45 / $38,892.62
| Facility | | $15,566.44 | $25,739.45 | $38,892.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,552.67 / $36,552.67 / $36,552.67
| Facility | | $36,552.67 | $36,552.67 | $36,552.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,428.20 / $25,930.18 / $40,042.28
| Facility | | $22,428.20 | $25,930.18 | $40,042.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,833.49 / $67,369.37
| Facility | | $5,840.42 | $24,833.49 | $67,369.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $24,833.49 / $58,634.73
| Facility | | $3,775.00 | $24,833.49 | $58,634.73 |