- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Facility | | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $17,782.79 / $27,542.29
| Facility | | $10,964.78 | $17,782.79 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,307.81 / $47,863.01 / $50,118.72
| Facility | | $36,307.81 | $47,863.01 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $28,183.83
| Facility | | $12,022.64 | $12,022.64 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $15,848.93 / $25,118.86
| Facility | | $10,964.78 | $15,848.93 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $17,782.79 / $19,054.61
| Facility | | $13,803.84 | $17,782.79 | $19,054.61 |