- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $20,892.96 / $31,622.78
| Facility | | $12,882.50 | $20,892.96 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,153.52 / $48,977.88 / $51,286.14
| Facility | | $37,153.52 | $48,977.88 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $35,481.34
| Facility | | $12,302.69 | $12,302.69 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $19,952.62 / $31,622.78
| Facility | | $14,125.38 | $19,952.62 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $18,197.01 / $19,952.62
| Facility | | $14,454.40 | $18,197.01 | $19,952.62 |