- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,650.70 / $26,233.00 / $34,250.80
| Facility | | $12,650.70 | $26,233.00 | $34,250.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,646.66 / $64,149.68
| Facility | | $5,840.42 | $23,646.66 | $64,149.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,822.50 / $24,509.32 / $37,033.87
| Facility | | $14,822.50 | $24,509.32 | $37,033.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,805.76 / $34,805.76 / $34,805.76
| Facility | | $34,805.76 | $34,805.76 | $34,805.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,356.32 / $24,690.93 / $38,128.60
| Facility | | $21,356.32 | $24,690.93 | $38,128.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,646.66 / $64,149.68
| Facility | | $5,840.42 | $23,646.66 | $64,149.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,630.45 / $50,133.54
| Facility | | $5,840.42 | $18,630.45 | $50,133.54 |