- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,894.40 / $26,738.40 / $34,910.80
| Facility | | $12,894.40 | $26,738.40 | $34,910.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,417.64 / $65,385.67
| Facility | | $5,840.42 | $24,417.64 | $65,385.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,108.09 / $24,981.55 / $37,747.42
| Facility | | $15,108.09 | $24,981.55 | $37,747.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,476.37 / $35,476.37 / $35,476.37
| Facility | | $35,476.37 | $35,476.37 | $35,476.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,767.80 / $25,166.66 / $38,863.24
| Facility | | $21,767.80 | $25,166.66 | $38,863.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,417.64 / $65,385.67
| Facility | | $5,840.42 | $24,417.64 | $65,385.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,417.64 / $51,099.48
| Facility | | $5,840.42 | $24,417.64 | $51,099.48 |