- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,536.70 / $17,858.59 / $20,209.90
| Facility | | $11,536.70 | $17,858.59 | $20,209.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,618.59 / $17,572.77 / $23,733.36
| Facility | | $11,618.59 | $17,572.77 | $23,733.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,653.32 / $15,866.00 / $22,402.38
| Facility | | $10,653.32 | $15,866.00 | $22,402.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,955.00 / $17,069.00 / $21,471.00
| Facility | | $10,955.00 | $17,069.00 | $21,471.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,958.00 / $16,662.88 / $27,403.82
| Facility | | $4,958.00 | $16,662.88 | $27,403.82 |