- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,913.00 / $18,399.00 / $30,515.40
| Facility | | $11,913.00 | $18,399.00 | $30,515.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,414.41 / $15,942.81 / $26,429.11
| Facility | | $10,414.41 | $15,942.81 | $26,429.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,509.97 / $19,604.53 / $27,061.00
| Facility | | $14,509.97 | $19,604.53 | $27,061.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,472.12 / $19,681.74 / $46,569.14
| Facility | | $9,472.12 | $19,681.74 | $46,569.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,472.12 / $18,596.02 / $26,410.41
| Facility | | $9,472.12 | $18,596.02 | $26,410.41 |