- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $16,218.10
| Facility | | $16,218.10 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $23,988.33 / $38,904.51
| Facility | | $15,135.61 | $23,988.33 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,863.01 / $64,565.42 / $66,069.34
| Facility | | $47,863.01 | $64,565.42 | $66,069.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $38,018.94
| Facility | | $16,218.10 | $16,218.10 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $24,547.09 / $38,904.51
| Facility | | $17,378.01 | $24,547.09 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $25,703.96 / $87,096.36
| Facility | | $18,620.87 | $25,703.96 | $87,096.36 |