- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $14,125.38
| Facility | | $13,803.84 | $13,803.84 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $22,908.68 / $36,307.81
| Facility | | $14,125.38 | $22,908.68 | $36,307.81 |
- 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
- $13,803.84 / $14,125.38 / $34,673.69
| Facility | | $13,803.84 | $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
- $16,218.10 / $20,892.96 / $22,387.21
| Facility | | $16,218.10 | $20,892.96 | $22,387.21 |