- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $25,118.86
| Facility | | $23,988.33 | $23,988.33 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $39,810.72 / $63,095.73
| Facility | | $23,988.33 | $39,810.72 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72,443.60 / $95,499.26 / $100,000.00
| Facility | | $72,443.60 | $95,499.26 | $100,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $25,118.86 / $57,543.99
| Facility | | $23,988.33 | $25,118.86 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $37,153.52 / $56,234.13
| Facility | | $26,302.68 | $37,153.52 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $38,904.51 / $50,118.72
| Facility | | $28,183.83 | $38,904.51 | $50,118.72 |