- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $16,218.10 / $18,620.87
| Facility | | $12,589.25 | $16,218.10 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $19,498.45 / $20,892.96
| Facility | | $12,882.50 | $19,498.45 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $15,135.61 / $18,197.01
| Facility | | $12,882.50 | $15,135.61 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $18,620.87 / $23,442.29
| Facility | | $11,481.54 | $18,620.87 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $22,387.21 / $25,118.86
| Facility | | $14,791.08 | $22,387.21 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $18,197.01 / $23,988.33
| Facility | | $1,862.09 | $18,197.01 | $23,988.33 |