- 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
- $11,220.18 / $18,197.01 / $27,542.29
| Facility | | $11,220.18 | $18,197.01 | $27,542.29 |
- 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 / $29,512.09
| Facility | | $11,748.98 | $11,748.98 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $17,378.01 / $26,915.35
| Facility | | $12,022.64 | $17,378.01 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $17,378.01 / $19,054.61
| Facility | | $13,803.84 | $17,378.01 | $19,054.61 |