- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $21,877.62 / $28,840.32
| Facility | | $13,489.63 | $21,877.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $26,915.35 / $33,113.11
| Facility | | $18,197.01 | $26,915.35 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $25,703.96 / $25,703.96
| Facility | | $25,703.96 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $20,417.38 / $26,915.35
| Facility | | $13,803.84 | $20,417.38 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $25,703.96 / $25,703.96
| Facility | | $25,703.96 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $19,054.61 / $29,512.09
| Facility | | $12,022.64 | $19,054.61 | $29,512.09 |