- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $21,379.62 / $40,738.03
| Facility | | $13,803.84 | $21,379.62 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $12,022.64 / $21,379.62
| Facility | | $11,220.18 | $12,022.64 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $18,197.01 / $28,840.32
| Facility | | $12,022.64 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $19,054.61 / $34,673.69
| Facility | | $10,232.93 | $19,054.61 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $19,054.61 / $26,915.35
| Facility | | $6,309.57 | $19,054.61 | $26,915.35 |