- 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
- $14,125.38 / $23,442.29 / $36,307.81
| Facility | | $14,125.38 | $23,442.29 | $36,307.81 |
- 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 / $36,307.81
| Facility | | $15,488.17 | $15,488.17 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $25,118.86 / $36,307.81
| Facility | | $16,982.44 | $25,118.86 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $22,908.68 / $24,547.09
| Facility | | $17,782.79 | $22,908.68 | $24,547.09 |