- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $19,498.45 / $25,703.96
| Facility | | $12,022.64 | $19,498.45 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $22,387.21 / $27,542.29
| Facility | | $15,135.61 | $22,387.21 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $23,442.29
| Facility | | $23,442.29 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $17,782.79 / $23,988.33
| Facility | | $12,302.69 | $17,782.79 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $23,442.29
| Facility | | $23,442.29 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $16,982.44 / $26,915.35
| Facility | | $10,715.19 | $16,982.44 | $26,915.35 |