- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $23,442.29 / $26,915.35
| Facility | | $18,197.01 | $23,442.29 | $26,915.35 |
- 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
- $17,782.79 / $20,892.96 / $25,118.86
| Facility | | $17,782.79 | $20,892.96 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $26,915.35 / $33,884.42
| Facility | | $16,595.87 | $26,915.35 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,199.52 / $30,199.52 / $30,199.52
| Facility | | $30,199.52 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $26,915.35 / $34,673.69
| Facility | | $1,862.09 | $26,915.35 | $34,673.69 |