- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $16,218.10 / $19,498.45
| Facility | | $13,489.63 | $16,218.10 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,791.08 / $23,442.29
| Facility | | $14,454.40 | $14,791.08 | $23,442.29 |
- 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
- $12,882.50 / $16,595.87 / $26,302.68
| Facility | | $12,882.50 | $16,595.87 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $21,877.62 / $21,877.62
| Facility | | $10,471.29 | $21,877.62 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $18,620.87 / $27,542.29
| Facility | | $13,489.63 | $18,620.87 | $27,542.29 |