- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,817.50 / $28,652.50 / $37,409.90
| Facility | | $13,817.50 | $28,652.50 | $37,409.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,827.68 / $70,066.42
| Facility | | $5,840.42 | $25,827.68 | $70,066.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,189.63 / $26,769.90 / $40,449.64
| Facility | | $16,189.63 | $26,769.90 | $40,449.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,016.01 / $38,016.01 / $38,016.01
| Facility | | $38,016.01 | $38,016.01 | $38,016.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,326.09 / $26,968.27 / $41,645.33
| Facility | | $23,326.09 | $26,968.27 | $41,645.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,827.68 / $70,066.42
| Facility | | $5,840.42 | $25,827.68 | $70,066.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,348.80 / $54,757.54
| Facility | | $5,840.42 | $20,348.80 | $54,757.54 |