- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $15,848.93
| Facility | | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $26,302.68 / $43,651.58
| Facility | | $15,848.93 | $26,302.68 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47,863.01 / $63,095.73 / $66,069.34
| Facility | | $47,863.01 | $63,095.73 | $66,069.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $42,657.95
| Facility | | $15,848.93 | $15,848.93 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $27,542.29 / $44,668.36
| Facility | | $18,197.01 | $27,542.29 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $25,703.96 / $63,095.73
| Facility | | $18,620.87 | $25,703.96 | $63,095.73 |