- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $26,302.68
| Facility | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $91.20 / $3,467.37
| Facility | | $74.13 | $91.20 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $40,738.03
| Facility | | $25,118.86 | $25,118.86 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $223.87 / $28,183.83
| Facility | | $141.25 | $223.87 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $40,738.03
| Facility | | $25,118.86 | $25,118.86 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,630.78 / $3,715.35
| Facility | | $3,467.37 | $3,630.78 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $23,442.29 / $63,095.73
| Facility | | $5,370.32 | $23,442.29 | $63,095.73 |