- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,935.10 / $25,525.80 / $36,141.80
| Facility | | $13,935.10 | $25,525.80 | $36,141.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,872.71 / $25,199.76 / $39,931.11
| Facility | | $15,872.71 | $25,199.76 | $39,931.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,488.32 / $22,961.79 / $40,852.67
| Facility | | $14,488.32 | $22,961.79 | $40,852.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $21,806.96 / $48,308.36
| Facility | | $7,117.00 | $21,806.96 | $48,308.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $21,192.46 / $42,929.33
| Facility | | $3,308.00 | $21,192.46 | $42,929.33 |