- 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
- $12,022.64 / $19,498.45 / $30,902.95
| Facility | | $12,022.64 | $19,498.45 | $30,902.95 |
- 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 / $30,902.95
| Facility | | $13,182.57 | $13,182.57 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $20,417.38 / $30,902.95
| Facility | | $14,454.40 | $20,417.38 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $19,498.45 / $21,379.62
| Facility | | $15,488.17 | $19,498.45 | $21,379.62 |