- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,318.50 / $20,616.80 / $23,331.10
| Facility | | $13,318.50 | $20,616.80 | $23,331.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,094.32 / $19,804.77 / $26,747.84
| Facility | | $13,094.32 | $19,804.77 | $26,747.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,298.65 / $16,940.84 / $25,862.27
| Facility | | $12,298.65 | $16,940.84 | $25,862.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,881.36 / $18,304.00 / $24,662.00
| Facility | | $11,881.36 | $18,304.00 | $24,662.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $18,494.98 / $31,636.15
| Facility | | $5,274.00 | $18,494.98 | $31,636.15 |