- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $17,782.79 / $27,542.29
| Facility | | $10,715.19 | $17,782.79 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $44,668.36 / $46,773.51
| Facility | | $33,884.42 | $44,668.36 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $25,118.86
| Facility | | $11,220.18 | $11,220.18 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $17,378.01 / $25,703.96
| Facility | | $11,748.98 | $17,378.01 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,595.87 / $17,782.79
| Facility | | $12,882.50 | $16,595.87 | $17,782.79 |