- 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
- $17,782.79 / $28,840.32 / $44,668.36
| Facility | | $17,782.79 | $28,840.32 | $44,668.36 |
- 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 / $44,668.36
| Facility | | $18,197.01 | $18,197.01 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $29,512.09 / $42,657.95
| Facility | | $20,417.38 | $29,512.09 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $29,512.09 / $46,773.51
| Facility | | $21,379.62 | $29,512.09 | $46,773.51 |