- 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
- $13,803.84 / $22,908.68 / $37,153.52
| Facility | | $13,803.84 | $22,908.68 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,977.88 / $64,565.42 / $67,608.30
| Facility | | $48,977.88 | $64,565.42 | $67,608.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $35,481.34
| Facility | | $16,218.10 | $16,218.10 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $25,703.96 / $38,018.94
| Facility | | $17,378.01 | $25,703.96 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $25,703.96 / $60,255.96
| Facility | | $18,620.87 | $25,703.96 | $60,255.96 |