- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,518.80 / $28,033.20 / $36,601.30
| Facility | | $13,518.80 | $28,033.20 | $36,601.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,600.06 / $68,551.96
| Facility | | $5,840.42 | $25,600.06 | $68,551.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,839.69 / $26,191.28 / $39,575.33
| Facility | | $15,839.69 | $26,191.28 | $39,575.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,812.25 / $33,812.25 / $33,812.25
| Facility | | $33,812.25 | $33,812.25 | $33,812.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,821.90 / $26,385.35 / $40,745.18
| Facility | | $22,821.90 | $26,385.35 | $40,745.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,600.06 / $68,551.96
| Facility | | $5,840.42 | $25,600.06 | $68,551.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,600.06 / $53,573.96
| Facility | | $5,840.42 | $25,600.06 | $53,573.96 |