- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $19,054.61 / $26,915.35
| Facility | | $12,589.25 | $19,054.61 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $18,620.87
| Facility | | $18,620.87 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,715.19 / $18,197.01
| Facility | | $3,981.07 | $10,715.19 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $18,197.01 / $30,199.52
| Facility | | $13,182.57 | $18,197.01 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $18,197.01 / $25,703.96
| Facility | | $14,125.38 | $18,197.01 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $16,982.44 / $25,703.96
| Facility | | $8,912.51 | $16,982.44 | $25,703.96 |