- 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
- $13,489.63 / $23,442.29 / $36,307.81
| Facility | | $13,489.63 | $23,442.29 | $36,307.81 |
- 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 / $26,302.68
| Facility | | $11,481.54 | $11,481.54 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $19,952.62 / $28,840.32
| Facility | | $13,489.63 | $19,952.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $16,982.44 / $18,197.01
| Facility | | $13,182.57 | $16,982.44 | $18,197.01 |