- 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
- $17,378.01 / $25,703.96 / $31,622.78
| Facility | | $17,378.01 | $25,703.96 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $26,302.68
| Facility | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $20,417.38 / $27,542.29
| Facility | | $13,489.63 | $20,417.38 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $26,302.68
| Facility | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $19,054.61 / $30,199.52
| Facility | | $12,022.64 | $19,054.61 | $30,199.52 |