- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,584.20 / $16,147.60 / $26,808.90
| Facility | | $12,584.20 | $16,147.60 | $26,808.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,501.35 / $15,731.64 / $26,649.73
| Facility | | $10,501.35 | $15,731.64 | $26,649.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,014.28 / $17,997.20 / $28,174.00
| Facility | | $14,014.28 | $17,997.20 | $28,174.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,652.50 / $16,544.96 / $48,537.00
| Facility | | $8,652.50 | $16,544.96 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,652.50 / $16,508.97 / $23,202.54
| Facility | | $8,652.50 | $16,508.97 | $23,202.54 |