- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.00 / $31,203.10 / $40,740.10
| Facility | | $3,822.00 | $31,203.10 | $40,740.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $28,494.85 / $76,303.63
| Facility | | $5,840.42 | $28,494.85 | $76,303.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,630.80 / $29,152.92 / $44,050.40
| Facility | | $17,630.80 | $29,152.92 | $44,050.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,400.14 / $41,400.14 / $41,400.14
| Facility | | $41,400.14 | $41,400.14 | $41,400.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,402.54 / $29,368.94 / $45,352.53
| Facility | | $25,402.54 | $29,368.94 | $45,352.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $28,494.85 / $76,303.63
| Facility | | $5,840.42 | $28,494.85 | $76,303.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $28,494.85 / $59,631.96
| Facility | | $5,840.42 | $28,494.85 | $59,631.96 |