- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,125.38
| Facility | | $14,125.38 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $21,379.62 / $33,884.42
| Facility | | $13,182.57 | $21,379.62 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42,657.95 / $56,234.13 / $58,884.37
| Facility | | $42,657.95 | $56,234.13 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $34,673.69
| Facility | | $14,125.38 | $14,125.38 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $22,908.68 / $33,884.42
| Facility | | $15,848.93 | $22,908.68 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $22,908.68 / $70,794.58
| Facility | | $16,595.87 | $22,908.68 | $70,794.58 |