- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $21,877.62 / $21,877.62
| Facility | | $21,877.62 | $21,877.62 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $34,673.69 / $53,703.18
| Facility | | $21,379.62 | $34,673.69 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64,565.42 / $85,113.80 / $89,125.09
| Facility | | $64,565.42 | $85,113.80 | $89,125.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $21,877.62 / $52,480.75
| Facility | | $21,877.62 | $21,877.62 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $34,673.69 / $52,480.75
| Facility | | $24,547.09 | $34,673.69 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $31,622.78 / $34,673.69
| Facility | | $25,118.86 | $31,622.78 | $34,673.69 |