- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $19,952.62 / $26,915.35
| Facility | | $12,589.25 | $19,952.62 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $25,703.96 / $32,359.37
| Facility | | $17,782.79 | $25,703.96 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $19,054.61 / $25,118.86
| Facility | | $12,882.50 | $19,054.61 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $17,782.79 / $27,542.29
| Facility | | $11,220.18 | $17,782.79 | $27,542.29 |