- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $22,387.21 / $30,199.52
| Facility | | $13,803.84 | $22,387.21 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $23,988.33 / $29,512.09
| Facility | | $16,218.10 | $23,988.33 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $26,915.35
| Facility | | $26,915.35 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $19,952.62 / $28,183.83
| Facility | | $14,125.38 | $19,952.62 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $26,915.35
| Facility | | $26,915.35 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $19,952.62 / $30,902.95
| Facility | | $12,589.25 | $19,952.62 | $30,902.95 |