- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $25,118.86
| Facility | | $25,118.86 | $25,118.86 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $46,773.51 / $72,443.60
| Facility | | $29,512.09 | $46,773.51 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75,857.76 / $100,000.00 / $104,712.85
| Facility | | $75,857.76 | $100,000.00 | $104,712.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $63,095.73
| Facility | | $25,118.86 | $25,118.86 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $42,657.95 / $63,095.73
| Facility | | $29,512.09 | $42,657.95 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $40,738.03 / $56,234.13
| Facility | | $29,512.09 | $40,738.03 | $56,234.13 |