- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,382.40 / $21,002.70 / $27,604.70
| Facility | | $14,382.40 | $21,002.70 | $27,604.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,817.16 / $15,842.31 / $26,795.14
| Facility | | $5,817.16 | $15,842.31 | $26,795.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,610.60 / $21,095.99 / $35,309.92
| Facility | | $14,610.60 | $21,095.99 | $35,309.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,091.16 / $23,543.40 / $34,375.28
| Facility | | $18,091.16 | $23,543.40 | $34,375.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,091.16 / $21,886.73 / $34,375.28
| Facility | | $18,091.16 | $21,886.73 | $34,375.28 |