- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $16,982.44 / $19,952.62
| Facility | | $10,964.78 | $16,982.44 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $18,197.01 / $24,547.09
| Facility | | $12,302.69 | $18,197.01 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $15,848.93 / $21,877.62
| Facility | | $10,232.93 | $15,848.93 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $17,378.01 / $20,892.96
| Facility | | $11,481.54 | $17,378.01 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $17,378.01 / $26,302.68
| Facility | | $4,073.80 | $17,378.01 | $26,302.68 |