- 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
- $12,022.64 / $20,892.96 / $36,307.81
| Facility | | $12,022.64 | $20,892.96 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53,703.18 / $72,443.60 / $74,131.02
| Facility | | $53,703.18 | $72,443.60 | $74,131.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $37,153.52
| Facility | | $18,197.01 | $18,197.01 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $27,542.29 / $39,810.72
| Facility | | $18,620.87 | $27,542.29 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $26,915.35 / $28,840.32
| Facility | | $20,892.96 | $26,915.35 | $28,840.32 |