- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,541.60 / $26,006.80 / $33,955.50
| Facility | | $12,541.60 | $26,006.80 | $33,955.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,442.76 / $63,596.53
| Facility | | $5,840.42 | $23,442.76 | $63,596.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,694.69 / $24,297.98 / $36,714.54
| Facility | | $14,694.69 | $24,297.98 | $36,714.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,505.64 / $34,505.64 / $34,505.64
| Facility | | $34,505.64 | $34,505.64 | $34,505.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,172.17 / $24,478.03 / $37,799.83
| Facility | | $21,172.17 | $24,478.03 | $37,799.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,442.76 / $63,596.53
| Facility | | $5,840.42 | $23,442.76 | $63,596.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,469.80 / $49,701.25
| Facility | | $5,840.42 | $18,469.80 | $49,701.25 |