- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $37,153.52 / $56,234.13
| Facility | | $22,908.68 | $37,153.52 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,095.73 / $85,113.80 / $87,096.36
| Facility | | $63,095.73 | $85,113.80 | $87,096.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $50,118.72
| Facility | | $21,379.62 | $21,379.62 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $32,359.37 / $46,773.51
| Facility | | $22,387.21 | $32,359.37 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $33,884.42 / $72,443.60
| Facility | | $24,547.09 | $33,884.42 | $72,443.60 |