- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $24,547.09
| Facility | | $24,547.09 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $40,738.03 / $63,095.73
| Facility | | $25,703.96 | $40,738.03 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74,131.02 / $97,723.72 / $102,329.30
| Facility | | $74,131.02 | $97,723.72 | $102,329.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $60,255.96
| Facility | | $24,547.09 | $24,547.09 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $39,810.72 / $57,543.99
| Facility | | $27,542.29 | $39,810.72 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $36,307.81 / $39,810.72
| Facility | | $28,840.32 | $36,307.81 | $39,810.72 |