- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $28,183.83 / $30,902.95
| Facility | | $16,982.44 | $28,183.83 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $28,183.83 / $38,904.51
| Facility | | $19,054.61 | $28,183.83 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $22,908.68 / $33,884.42
| Facility | | $15,488.17 | $22,908.68 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $21,877.62 / $30,902.95
| Facility | | $14,125.38 | $21,877.62 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $26,915.35 / $40,738.03
| Facility | | $4,073.80 | $26,915.35 | $40,738.03 |