- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $26,915.35
| Facility | | $26,915.35 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $48,977.88 / $74,131.02
| Facility | | $29,512.09 | $48,977.88 | $74,131.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81,283.05 / $107,151.93 / $112,201.85
| Facility | | $81,283.05 | $107,151.93 | $112,201.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $60,255.96
| Facility | | $26,915.35 | $26,915.35 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,512.09 / $43,651.58 / $63,095.73
| Facility | | $29,512.09 | $43,651.58 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $39,810.72 / $43,651.58
| Facility | | $31,622.78 | $39,810.72 | $43,651.58 |