- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $19,498.45 / $22,908.68
| Facility | | $12,589.25 | $19,498.45 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $21,379.62 / $28,183.83
| Facility | | $14,125.38 | $21,379.62 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,982.44 / $25,118.86
| Facility | | $11,748.98 | $16,982.44 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $18,620.87 / $23,442.29
| Facility | | $13,489.63 | $18,620.87 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $19,952.62 / $30,199.52
| Facility | | $4,073.80 | $19,952.62 | $30,199.52 |