- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $17,378.01
| Facility | | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $46,773.51 / $89,125.09
| Facility | | $19,952.62 | $46,773.51 | $89,125.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52,480.75 / $69,183.10 / $72,443.60
| Facility | | $52,480.75 | $69,183.10 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $40,738.03
| Facility | | $17,378.01 | $17,378.01 | $40,738.03 |
- 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
- $19,952.62 / $25,703.96 / $27,542.29
| Facility | | $19,952.62 | $25,703.96 | $27,542.29 |