- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,999.70 / $26,956.80 / $35,195.90
| Facility | | $12,999.70 | $26,956.80 | $35,195.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,617.09 / $65,919.74
| Facility | | $5,840.42 | $24,617.09 | $65,919.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,231.49 / $25,185.60 / $38,055.74
| Facility | | $15,231.49 | $25,185.60 | $38,055.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,766.14 / $35,766.14 / $35,766.14
| Facility | | $35,766.14 | $35,766.14 | $35,766.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,945.60 / $25,372.22 / $39,180.67
| Facility | | $21,945.60 | $25,372.22 | $39,180.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,617.09 / $65,919.74
| Facility | | $5,840.42 | $24,617.09 | $65,919.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,617.09 / $51,516.86
| Facility | | $5,840.42 | $24,617.09 | $51,516.86 |