- 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 / $40,738.03
| Facility | | $15,848.93 | $26,302.68 | $40,738.03 |
- 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 / $38,904.51
| Facility | | $15,848.93 | $15,848.93 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $26,302.68 / $38,904.51
| Facility | | $16,595.87 | $26,302.68 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $23,442.29 / $25,703.96
| Facility | | $18,620.87 | $23,442.29 | $25,703.96 |