- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,956.70 / $18,920.70 / $24,868.30
| Facility | | $12,956.70 | $18,920.70 | $24,868.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,377.19 / $14,644.11 / $24,768.55
| Facility | | $5,377.19 | $14,644.11 | $24,768.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,637.57 / $19,092.36 / $34,055.37
| Facility | | $13,637.57 | $19,092.36 | $34,055.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,297.82 / $21,209.58 / $30,967.72
| Facility | | $16,297.82 | $21,209.58 | $30,967.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,297.82 / $19,717.14 / $30,967.72
| Facility | | $16,297.82 | $19,717.14 | $30,967.72 |