- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,383.60 / $25,679.20 / $33,527.80
| Facility | | $12,383.60 | $25,679.20 | $33,527.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,147.46 / $62,795.42
| Facility | | $5,840.42 | $23,147.46 | $62,795.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,509.58 / $23,991.91 / $36,252.06
| Facility | | $14,509.58 | $23,991.91 | $36,252.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,070.98 / $34,070.98 / $34,070.98
| Facility | | $34,070.98 | $34,070.98 | $34,070.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,905.47 / $24,169.69 / $37,323.67
| Facility | | $20,905.47 | $24,169.69 | $37,323.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,147.46 / $62,795.42
| Facility | | $5,840.42 | $23,147.46 | $62,795.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,237.14 / $49,075.18
| Facility | | $5,840.42 | $18,237.14 | $49,075.18 |