- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,241.40 / $14,935.40 / $24,244.80
| Facility | | $10,241.40 | $14,935.40 | $24,244.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,574.53 / $22,141.52 / $28,386.56
| Facility | | $15,574.53 | $22,141.52 | $28,386.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,025.81 / $23,250.78 / $29,408.03
| Facility | | $12,025.81 | $23,250.78 | $29,408.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,685.20 / $16,061.90 / $25,683.70
| Facility | | $10,685.20 | $16,061.90 | $25,683.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,063.15 / $21,368.68 / $32,465.24
| Facility | | $14,063.15 | $21,368.68 | $32,465.24 |