- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $20,417.38 / $26,915.35
| Facility | | $12,589.25 | $20,417.38 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $20,892.96 / $20,892.96
| Facility | | $20,892.96 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $18,620.87 / $23,442.29
| Facility | | $12,882.50 | $18,620.87 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $19,498.45 / $25,703.96
| Facility | | $12,882.50 | $19,498.45 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $17,782.79 / $27,542.29
| Facility | | $11,220.18 | $17,782.79 | $27,542.29 |