- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $17,378.01 / $32,359.37
| Facility | | $10,471.29 | $17,378.01 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $53,703.18 / $56,234.13
| Facility | | $40,738.03 | $53,703.18 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $30,199.52
| Facility | | $13,489.63 | $13,489.63 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $21,877.62 / $33,113.11
| Facility | | $14,791.08 | $21,877.62 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $19,952.62 / $21,877.62
| Facility | | $15,848.93 | $19,952.62 | $21,877.62 |