- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $27,542.29 / $27,542.29
| Facility | | $27,542.29 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $43,651.58 / $67,608.30
| Facility | | $26,302.68 | $43,651.58 | $67,608.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83,176.38 / $109,647.82 / $114,815.36
| Facility | | $83,176.38 | $109,647.82 | $114,815.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $27,542.29 / $63,095.73
| Facility | | $27,542.29 | $27,542.29 | $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
- $31,622.78 / $43,651.58 / $91,201.08
| Facility | | $31,622.78 | $43,651.58 | $91,201.08 |