- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $20,892.96 / $26,915.35
| Facility | | $15,135.61 | $20,892.96 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $18,620.87 / $25,703.96
| Facility | | $12,022.64 | $18,620.87 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $21,877.62 / $30,902.95
| Facility | | $11,481.54 | $21,877.62 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $21,379.62 / $25,703.96
| Facility | | $12,022.64 | $21,379.62 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $21,877.62 / $30,902.95
| Facility | | $10,964.78 | $21,877.62 | $30,902.95 |