- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $16,218.10 / $23,988.33
| Facility | | $13,489.63 | $16,218.10 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $26,302.68 / $34,673.69
| Facility | | $18,197.01 | $26,302.68 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $21,379.62 / $29,512.09
| Facility | | $17,378.01 | $21,379.62 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $21,379.62 / $28,183.83
| Facility | | $12,882.50 | $21,379.62 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $19,952.62 / $30,199.52
| Facility | | $12,882.50 | $19,952.62 | $30,199.52 |