- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,866.30 / $23,012.80 / $26,042.70
| Facility | | $14,866.30 | $23,012.80 | $26,042.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,120.86 / $21,357.40 / $29,374.34
| Facility | | $14,120.86 | $21,357.40 | $29,374.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,718.68 / $21,183.73 / $32,344.11
| Facility | | $13,718.68 | $21,183.73 | $32,344.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,156.00 / $20,832.00 / $27,813.00
| Facility | | $12,156.00 | $20,832.00 | $27,813.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $26,596.55 / $35,397.87
| Facility | | $5,274.00 | $26,596.55 | $35,397.87 |