- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,410.20 / $24,597.70 / $39,981.60
| Facility | | $14,410.20 | $24,597.70 | $39,981.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,844.77 / $14,844.77 / $14,844.77
| Facility | | $14,844.77 | $14,844.77 | $14,844.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,310.67 / $19,544.11 / $30,832.73
| Facility | | $12,310.67 | $19,544.11 | $30,832.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,343.71 / $26,202.80 / $51,928.68
| Facility | | $12,343.71 | $26,202.80 | $51,928.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,405.52 / $22,240.87 / $29,607.68
| Facility | | $14,405.52 | $22,240.87 | $29,607.68 |