- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $16,595.87 / $23,988.33
| Facility | | $13,803.84 | $16,595.87 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $26,302.68 / $35,481.34
| Facility | | $18,620.87 | $26,302.68 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $21,379.62 / $30,199.52
| Facility | | $17,378.01 | $21,379.62 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $21,379.62 / $28,840.32
| Facility | | $12,882.50 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $21,877.62 / $30,199.52
| Facility | | $13,182.57 | $21,877.62 | $30,199.52 |