- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $20,892.96 / $43,651.58
| Facility | | $14,791.08 | $20,892.96 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $25,118.86 / $37,153.52
| Facility | | $14,791.08 | $25,118.86 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $25,703.96 / $39,810.72
| Facility | | $17,782.79 | $25,703.96 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $21,379.62 / $28,840.32
| Facility | | $13,803.84 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $23,442.29 / $33,884.42
| Facility | | $3,890.45 | $23,442.29 | $33,884.42 |