- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $13,803.84 / $19,952.62
| Facility | | $11,481.54 | $13,803.84 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $22,387.21 / $29,512.09
| Facility | | $15,488.17 | $22,387.21 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $18,197.01 / $25,118.86
| Facility | | $14,791.08 | $18,197.01 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $18,197.01 / $23,988.33
| Facility | | $10,964.78 | $18,197.01 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $16,982.44 / $25,703.96
| Facility | | $10,964.78 | $16,982.44 | $25,703.96 |