- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $19,054.61
| Facility | | $19,054.61 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $26,915.35 / $44,668.36
| Facility | | $16,595.87 | $26,915.35 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,234.13 / $74,131.02 / $77,624.71
| Facility | | $56,234.13 | $74,131.02 | $77,624.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $43,651.58
| Facility | | $19,054.61 | $19,054.61 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $30,902.95 / $44,668.36
| Facility | | $20,417.38 | $30,902.95 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $27,542.29 / $30,199.52
| Facility | | $21,877.62 | $27,542.29 | $30,199.52 |