- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $21,379.62 / $25,118.86
| Facility | | $13,803.84 | $21,379.62 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $22,908.68 / $32,359.37
| Facility | | $15,488.17 | $22,908.68 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $20,892.96 / $32,359.37
| Facility | | $12,882.50 | $20,892.96 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $21,379.62 / $28,183.83
| Facility | | $14,454.40 | $21,379.62 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $19,952.62 / $33,113.11
| Facility | | $4,073.80 | $19,952.62 | $33,113.11 |