- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $22,387.21 / $22,387.21
| Facility | | $22,387.21 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $33,884.42 / $52,480.75
| Facility | | $20,417.38 | $33,884.42 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67,608.30 / $89,125.09 / $93,325.43
| Facility | | $67,608.30 | $89,125.09 | $93,325.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $22,387.21 / $47,863.01
| Facility | | $22,387.21 | $22,387.21 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $33,884.42 / $51,286.14
| Facility | | $22,908.68 | $33,884.42 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $33,884.42 / $37,153.52
| Facility | | $25,703.96 | $33,884.42 | $37,153.52 |