- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $21,379.62 / $21,877.62
| Facility | | $17,782.79 | $21,379.62 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $22,908.68 / $33,113.11
| Facility | | $13,182.57 | $22,908.68 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $18,620.87 / $33,113.11
| Facility | | $13,803.84 | $18,620.87 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $17,782.79 / $22,908.68
| Facility | | $15,488.17 | $17,782.79 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $20,892.96 / $34,673.69
| Facility | | $13,182.57 | $20,892.96 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $13,489.63 / $17,782.79
| Facility | | $151.36 | $13,489.63 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $24,547.09 / $25,118.86
| Facility | | $19,498.45 | $24,547.09 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $22,387.21 / $30,902.95
| Facility | | $13,182.57 | $22,387.21 | $30,902.95 |