- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $19,498.45
| Facility | | $19,054.61 | $19,054.61 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $33,884.42 / $50,118.72
| Facility | | $25,703.96 | $33,884.42 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $28,183.83 / $34,673.69
| Facility | | $14,125.38 | $28,183.83 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $28,183.83
| Facility | | $16,982.44 | $16,982.44 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $16,982.44 / $66,069.34
| Facility | | $6,606.93 | $16,982.44 | $66,069.34 |