- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.00 / $42,444.50 / $56,687.90
| Facility | | $3,822.00 | $42,444.50 | $56,687.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $38,760.51 / $103,793.08
| Facility | | $5,840.42 | $38,760.51 | $103,793.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,060.14 / $39,655.66 / $59,920.18
| Facility | | $23,060.14 | $39,655.66 | $59,920.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,315.12 / $56,315.12 / $56,315.12
| Facility | | $56,315.12 | $56,315.12 | $56,315.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,554.16 / $39,949.51 / $61,691.42
| Facility | | $34,554.16 | $39,949.51 | $61,691.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $38,760.51 / $103,793.08
| Facility | | $5,840.42 | $38,760.51 | $103,793.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $38,760.51 / $81,115.21
| Facility | | $5,840.42 | $38,760.51 | $81,115.21 |