- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $14,791.08
| Facility | | $14,791.08 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $21,877.62 / $35,481.34
| Facility | | $13,182.57 | $21,877.62 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $58,884.37 / $61,659.50
| Facility | | $44,668.36 | $58,884.37 | $61,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $33,884.42
| Facility | | $14,791.08 | $14,791.08 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $24,547.09 / $36,307.81
| Facility | | $16,218.10 | $24,547.09 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $23,442.29 / $31,622.78
| Facility | | $16,982.44 | $23,442.29 | $31,622.78 |