- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,567.90 / $26,509.20 / $53,873.70
| Facility | | $20,567.90 | $26,509.20 | $53,873.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,258.82 / $26,648.38 / $30,465.99
| Facility | | $21,258.82 | $26,648.38 | $30,465.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,417.54 / $29,060.78 / $37,794.79
| Facility | | $16,417.54 | $29,060.78 | $37,794.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,872.42 / $38,872.42 / $38,872.42
| Facility | | $38,872.42 | $38,872.42 | $38,872.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $29,838.60 / $40,874.51
| Facility | | $2,000.00 | $29,838.60 | $40,874.51 |