- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $15,488.17
| Facility | | $15,488.17 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $28,840.32 / $44,668.36
| Facility | | $18,197.01 | $28,840.32 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $61,659.50 / $64,565.42
| Facility | | $46,773.51 | $61,659.50 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $28,840.32
| Facility | | $15,488.17 | $15,488.17 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $25,118.86 / $87,096.36
| Facility | | $18,197.01 | $25,118.86 | $87,096.36 |