- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $19,498.45 / $30,199.52
| Facility | | $12,302.69 | $19,498.45 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,810.72 / $52,480.75 / $54,954.09
| Facility | | $39,810.72 | $52,480.75 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $29,512.09
| Facility | | $13,182.57 | $13,182.57 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,197.01 / $30,199.52
| Facility | | $13,803.84 | $18,197.01 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $21,379.62 / $63,095.73
| Facility | | $15,488.17 | $21,379.62 | $63,095.73 |