- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $42,657.95 / $75,857.76
| Facility | | $16,595.87 | $42,657.95 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,657.95 / $64,565.42 / $81,283.05
| Facility | | $42,657.95 | $64,565.42 | $81,283.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,673.69 / $53,703.18 / $69,183.10
| Facility | | $34,673.69 | $53,703.18 | $69,183.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $48,977.88 / $120,226.44
| Facility | | $27,542.29 | $48,977.88 | $120,226.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $20,892.96
| Facility | | $17,378.01 | $17,378.01 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $42,657.95 / $72,443.60
| Facility | | $10,000.00 | $42,657.95 | $72,443.60 |