- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $14,454.40 / $20,892.96
| Facility | | $12,022.64 | $14,454.40 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $22,908.68 / $30,902.95
| Facility | | $16,218.10 | $22,908.68 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $18,620.87 / $26,302.68
| Facility | | $15,488.17 | $18,620.87 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $18,620.87 / $25,118.86
| Facility | | $11,481.54 | $18,620.87 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $17,378.01 / $26,302.68
| Facility | | $11,481.54 | $17,378.01 | $26,302.68 |