- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $22,387.21 / $25,703.96
| Facility | | $17,378.01 | $22,387.21 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Facility | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $20,417.38 / $25,118.86
| Facility | | $17,378.01 | $20,417.38 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $25,703.96 / $32,359.37
| Facility | | $15,848.93 | $25,703.96 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,113.11 / $33,113.11 / $33,113.11
| Facility | | $33,113.11 | $33,113.11 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $25,703.96 / $33,113.11
| Facility | | $1,862.09 | $25,703.96 | $33,113.11 |