- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $17,782.79 / $20,892.96
| Facility | | $11,481.54 | $17,782.79 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $19,054.61 / $25,703.96
| Facility | | $12,882.50 | $19,054.61 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $16,218.10 / $22,908.68
| Facility | | $10,715.19 | $16,218.10 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $17,782.79 / $21,379.62
| Facility | | $12,302.69 | $17,782.79 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $17,782.79 / $27,542.29
| Facility | | $4,073.80 | $17,782.79 | $27,542.29 |