- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $26,302.68 / $41,686.94
| Facility | | $16,218.10 | $26,302.68 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,954.09 / $72,443.60 / $75,857.76
| Facility | | $54,954.09 | $72,443.60 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $41,686.94
| Facility | | $18,197.01 | $18,197.01 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $28,183.83 / $41,686.94
| Facility | | $19,498.45 | $28,183.83 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $26,915.35 / $28,840.32
| Facility | | $20,892.96 | $26,915.35 | $28,840.32 |