- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $23,442.29 / $27,542.29
| Facility | | $15,135.61 | $23,442.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $25,118.86 / $35,481.34
| Facility | | $16,982.44 | $25,118.86 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $22,908.68 / $33,884.42
| Facility | | $14,125.38 | $22,908.68 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $23,442.29 / $28,183.83
| Facility | | $16,218.10 | $23,442.29 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $23,988.33 / $36,307.81
| Facility | | $4,073.80 | $23,988.33 | $36,307.81 |