- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,613.60 / $28,229.80 / $36,857.90
| Facility | | $13,613.60 | $28,229.80 | $36,857.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,779.56 / $69,032.62
| Facility | | $5,840.42 | $25,779.56 | $69,032.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,950.76 / $26,374.92 / $39,852.82
| Facility | | $15,950.76 | $26,374.92 | $39,852.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,455.10 / $37,455.10 / $37,455.10
| Facility | | $37,455.10 | $37,455.10 | $37,455.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,981.92 / $26,570.36 / $41,030.87
| Facility | | $22,981.92 | $26,570.36 | $41,030.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,779.56 / $69,032.62
| Facility | | $5,840.42 | $25,779.56 | $69,032.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $25,779.56 / $53,949.60
| Facility | | $5,840.42 | $25,779.56 | $53,949.60 |