- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,774.60 / $28,563.60 / $37,293.80
| Facility | | $13,774.60 | $28,563.60 | $37,293.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,747.52 / $69,848.99
| Facility | | $5,840.42 | $25,747.52 | $69,848.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,139.39 / $26,686.83 / $40,324.11
| Facility | | $16,139.39 | $26,686.83 | $40,324.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,898.04 / $37,898.04 / $37,898.04
| Facility | | $37,898.04 | $37,898.04 | $37,898.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,253.70 / $26,884.57 / $41,516.08
| Facility | | $23,253.70 | $26,884.57 | $41,516.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,747.52 / $69,848.99
| Facility | | $5,840.42 | $25,747.52 | $69,848.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,285.65 / $54,587.60
| Facility | | $5,840.42 | $20,285.65 | $54,587.60 |