- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,820.60 / $31,458.80 / $51,805.80
| Facility | | $12,820.60 | $31,458.80 | $51,805.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,586.19 / $52,807.46 / $68,475.02
| Facility | | $35,586.19 | $52,807.46 | $68,475.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,646.00 / $41,574.89 / $66,473.87
| Facility | | $17,646.00 | $41,574.89 | $66,473.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,308.71 / $44,788.25 / $93,922.37
| Facility | | $23,308.71 | $44,788.25 | $93,922.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,830.80 / $16,830.80 / $16,830.80
| Facility | | $16,830.80 | $16,830.80 | $16,830.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,648.00 / $44,492.48 / $66,490.28
| Facility | | $17,648.00 | $44,492.48 | $66,490.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,281.00 / $29,770.08 / $57,185.76
| Facility | | $5,281.00 | $29,770.08 | $57,185.76 |