- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $19,054.61 / $21,877.62
| Facility | | $14,791.08 | $19,054.61 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $23,442.29
| Facility | | $23,442.29 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $15,488.17 / $18,620.87
| Facility | | $13,182.57 | $15,488.17 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $21,379.62 / $26,915.35
| Facility | | $13,489.63 | $21,379.62 | $26,915.35 |
- 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
- $1,862.09 / $21,379.62 / $27,542.29
| Facility | | $1,862.09 | $21,379.62 | $27,542.29 |