- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $14,791.08
| Facility | | $14,791.08 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $24,547.09 / $38,018.94
| Facility | | $15,135.61 | $24,547.09 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $58,884.37 / $61,659.50
| Facility | | $44,668.36 | $58,884.37 | $61,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $33,884.42
| Facility | | $14,791.08 | $14,791.08 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $23,988.33 / $34,673.69
| Facility | | $15,848.93 | $23,988.33 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $21,877.62 / $23,988.33
| Facility | | $17,378.01 | $21,877.62 | $23,988.33 |