- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,838.00 / $43,030.20 / $59,527.20
| Facility | | $12,838.00 | $43,030.20 | $59,527.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.00 / $3,000.00 / $12,093.52
| Facility | | $1,146.00 | $3,000.00 | $12,093.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,195.98 / $22,377.92 / $41,507.82
| Facility | | $16,195.98 | $22,377.92 | $41,507.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,195.98 / $23,108.40 / $41,507.82
| Facility | | $16,195.98 | $23,108.40 | $41,507.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,419.00 / $30,241.40 / $44,409.21
| Facility | | $5,419.00 | $30,241.40 | $44,409.21 |