- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $58,884.37 / $75,857.76
| Facility | | $40,738.03 | $58,884.37 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $25,118.86 / $53,703.18
| Facility | | $12,882.50 | $25,118.86 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $28,840.32 / $53,703.18
| Facility | | $20,892.96 | $28,840.32 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $28,840.32 / $53,703.18
| Facility | | $20,892.96 | $28,840.32 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $37,153.52 / $58,884.37
| Facility | | $5,370.32 | $37,153.52 | $58,884.37 |