- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $16,982.44
| Facility | | $16,982.44 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $20,417.38 / $36,307.81
| Facility | | $12,022.64 | $20,417.38 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,286.14 / $67,608.30 / $70,794.58
| Facility | | $51,286.14 | $67,608.30 | $70,794.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $33,884.42
| Facility | | $16,982.44 | $16,982.44 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $25,118.86 / $37,153.52
| Facility | | $17,378.01 | $25,118.86 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $25,118.86 / $26,915.35
| Facility | | $19,498.45 | $25,118.86 | $26,915.35 |