- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $11,748.98
| Facility | | $11,748.98 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $16,982.44 / $26,302.68
| Facility | | $10,232.93 | $16,982.44 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,481.34 / $46,773.51 / $48,977.88
| Facility | | $35,481.34 | $46,773.51 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $24,547.09
| Facility | | $11,748.98 | $11,748.98 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $17,782.79 / $26,302.68
| Facility | | $12,302.69 | $17,782.79 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $17,378.01 / $18,620.87
| Facility | | $13,489.63 | $17,378.01 | $18,620.87 |