- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $21,379.62 / $27,542.29
| Facility | | $15,135.61 | $21,379.62 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $18,620.87 / $25,703.96
| Facility | | $12,882.50 | $18,620.87 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $22,387.21 / $31,622.78
| Facility | | $11,748.98 | $22,387.21 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $21,379.62 / $25,118.86
| Facility | | $12,882.50 | $21,379.62 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $22,387.21 / $31,622.78
| Facility | | $10,964.78 | $22,387.21 | $31,622.78 |