- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $26,915.35 / $42,657.95
| Facility | | $16,595.87 | $26,915.35 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $66,069.34 / $69,183.10
| Facility | | $50,118.72 | $66,069.34 | $69,183.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $41,686.94
| Facility | | $16,595.87 | $16,595.87 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $26,915.35 / $39,810.72
| Facility | | $18,620.87 | $26,915.35 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $26,915.35 / $45,708.82
| Facility | | $19,498.45 | $26,915.35 | $45,708.82 |