- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $28,840.32 / $28,840.32
| Facility | | $28,840.32 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $46,773.51 / $70,794.58
| Facility | | $28,840.32 | $46,773.51 | $70,794.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87,096.36 / $114,815.36 / $120,226.44
| Facility | | $87,096.36 | $114,815.36 | $120,226.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $63,095.73 / $77,624.71
| Facility | | $28,840.32 | $63,095.73 | $77,624.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,199.52 / $41,686.94 / $63,095.73
| Facility | | $30,199.52 | $41,686.94 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $42,657.95 / $46,773.51
| Facility | | $33,884.42 | $42,657.95 | $46,773.51 |