- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Facility | | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $20,417.38 / $33,113.11
| Facility | | $12,589.25 | $20,417.38 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $54,954.09 / $57,543.99
| Facility | | $41,686.94 | $54,954.09 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $33,884.42
| Facility | | $13,803.84 | $13,803.84 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $22,908.68 / $33,113.11
| Facility | | $15,848.93 | $22,908.68 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $20,417.38 / $22,387.21
| Facility | | $16,218.10 | $20,417.38 | $22,387.21 |