- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Facility | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $23,442.29 / $36,307.81
| Facility | | $14,454.40 | $23,442.29 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $57,543.99 / $60,255.96
| Facility | | $43,651.58 | $57,543.99 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $35,481.34
| Facility | | $14,454.40 | $14,454.40 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $21,877.62 / $31,622.78
| Facility | | $15,135.61 | $21,877.62 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $21,379.62 / $23,442.29
| Facility | | $16,982.44 | $21,379.62 | $23,442.29 |