- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,289.40 / $27,557.40 / $35,980.10
| Facility | | $13,289.40 | $27,557.40 | $35,980.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,840.52 / $67,388.44
| Facility | | $5,840.42 | $24,840.52 | $67,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,570.85 / $25,746.74 / $38,903.62
| Facility | | $15,570.85 | $25,746.74 | $38,903.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,563.01 / $36,563.01 / $36,563.01
| Facility | | $36,563.01 | $36,563.01 | $36,563.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,434.55 / $25,937.52 / $40,053.62
| Facility | | $22,434.55 | $25,937.52 | $40,053.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,840.52 / $67,388.44
| Facility | | $5,840.42 | $24,840.52 | $67,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,571.05 / $52,664.66
| Facility | | $5,840.42 | $19,571.05 | $52,664.66 |