- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,837.20 / $31,888.80 / $41,912.80
| Facility | | $21,837.20 | $31,888.80 | $41,912.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,982.75 / $20,982.75 / $21,315.20
| Facility | | $20,982.75 | $20,982.75 | $21,315.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,539.54 / $25,979.76 / $43,941.27
| Facility | | $9,539.54 | $25,979.76 | $43,941.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,183.58 / $32,030.49 / $53,611.80
| Facility | | $22,183.58 | $32,030.49 | $53,611.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,468.20 / $35,746.44 / $52,192.73
| Facility | | $27,468.20 | $35,746.44 | $52,192.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,468.20 / $33,231.08 / $52,192.73
| Facility | | $27,468.20 | $33,231.08 | $52,192.73 |