- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $16,595.87 / $23,988.33
| Facility | | $10,232.93 | $16,595.87 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $26,915.35
| Facility | | $26,915.35 | $26,915.35 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $18,620.87 / $25,118.86
| Facility | | $12,302.69 | $18,620.87 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $16,595.87 / $26,915.35
| Facility | | $10,471.29 | $16,595.87 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $14,791.08 / $28,840.32
| Facility | | $4,073.80 | $14,791.08 | $28,840.32 |