- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,972.70 / $26,900.60 / $35,122.60
| Facility | | $12,972.70 | $26,900.60 | $35,122.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,565.80 / $65,782.41
| Facility | | $5,840.42 | $24,565.80 | $65,782.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,199.76 / $25,133.13 / $37,976.46
| Facility | | $15,199.76 | $25,133.13 | $37,976.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,691.62 / $35,691.62 / $35,691.62
| Facility | | $35,691.62 | $35,691.62 | $35,691.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,899.88 / $25,319.37 / $39,099.05
| Facility | | $21,899.88 | $25,319.37 | $39,099.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,565.80 / $65,782.41
| Facility | | $5,840.42 | $24,565.80 | $65,782.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,565.80 / $51,409.54
| Facility | | $5,840.42 | $24,565.80 | $51,409.54 |