- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $20,892.96 / $25,703.96
| Facility | | $20,892.96 | $20,892.96 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $54,954.09 / $83,176.38
| Facility | | $41,686.94 | $54,954.09 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $22,908.68 / $48,977.88
| Facility | | $21,379.62 | $22,908.68 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $28,183.83 / $44,668.36
| Facility | | $18,620.87 | $28,183.83 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $26,915.35 / $54,954.09
| Facility | | $12,302.69 | $26,915.35 | $54,954.09 |