- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $17,782.79 / $21,379.62
| Facility | | $14,454.40 | $17,782.79 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $15,848.93 / $25,703.96
| Facility | | $15,488.17 | $15,848.93 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $17,782.79 / $28,183.83
| Facility | | $13,803.84 | $17,782.79 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $25,118.86 / $25,118.86
| Facility | | $12,022.64 | $25,118.86 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $19,952.62 / $30,199.52
| Facility | | $14,454.40 | $19,952.62 | $30,199.52 |