- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $11,481.54
| Facility | | $11,481.54 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $16,982.44 / $28,183.83
| Facility | | $10,471.29 | $16,982.44 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,673.69 / $45,708.82 / $47,863.01
| Facility | | $34,673.69 | $45,708.82 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $28,183.83
| Facility | | $11,481.54 | $11,481.54 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $18,197.01 / $28,840.32
| Facility | | $12,589.25 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $16,982.44 / $18,620.87
| Facility | | $13,489.63 | $16,982.44 | $18,620.87 |