- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,063.30 / $23,317.70 / $26,387.70
| Facility | | $15,063.30 | $23,317.70 | $26,387.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,573.19 / $23,553.99 / $32,395.47
| Facility | | $15,573.19 | $23,553.99 | $32,395.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,909.88 / $21,464.41 / $32,772.67
| Facility | | $13,909.88 | $21,464.41 | $32,772.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,261.00 / $22,997.00 / $28,133.00
| Facility | | $14,261.00 | $22,997.00 | $28,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $21,756.47 / $35,780.75
| Facility | | $5,274.00 | $21,756.47 | $35,780.75 |