- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $17,782.79 / $17,782.79
| Facility | | $17,782.79 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $26,915.35 / $42,657.95
| Facility | | $16,218.10 | $26,915.35 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53,703.18 / $70,794.58 / $74,131.02
| Facility | | $53,703.18 | $70,794.58 | $74,131.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $17,782.79 / $39,810.72
| Facility | | $17,782.79 | $17,782.79 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $28,183.83 / $42,657.95
| Facility | | $19,054.61 | $28,183.83 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $26,302.68 / $28,183.83
| Facility | | $20,417.38 | $26,302.68 | $28,183.83 |