- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $21,877.62 / $40,738.03
| Facility | | $15,848.93 | $21,877.62 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $16,218.10
| Facility | | $16,218.10 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $21,877.62 / $27,542.29
| Facility | | $13,803.84 | $21,877.62 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $23,442.29 / $43,651.58
| Facility | | $15,135.61 | $23,442.29 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $21,877.62 / $28,840.32
| Facility | | $13,803.84 | $21,877.62 | $28,840.32 |