- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,869.70 / $16,826.00 / $19,041.30
| Facility | | $10,869.70 | $16,826.00 | $19,041.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,774.83 / $16,296.62 / $22,009.82
| Facility | | $10,774.83 | $16,296.62 | $22,009.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,037.35 / $14,761.27 / $21,107.09
| Facility | | $10,037.35 | $14,761.27 | $21,107.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,538.00 / $16,020.00 / $20,738.00
| Facility | | $10,538.00 | $16,020.00 | $20,738.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,008.00 / $15,094.39 / $25,819.35
| Facility | | $4,008.00 | $15,094.39 | $25,819.35 |