- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,205.10 / $14,997.80 / $23,155.40
| Facility | | $10,205.10 | $14,997.80 | $23,155.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,362.05 / $19,475.99 / $23,907.37
| Facility | | $15,362.05 | $19,475.99 | $23,907.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,069.13 / $29,952.91 / $38,401.17
| Facility | | $21,069.13 | $29,952.91 | $38,401.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,485.43 / $22,206.00 / $28,086.57
| Facility | | $11,485.43 | $22,206.00 | $28,086.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,205.10 / $15,340.20 / $24,529.60
| Facility | | $10,205.10 | $15,340.20 | $24,529.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,934.69 / $20,408.47 / $31,006.40
| Facility | | $11,934.69 | $20,408.47 | $31,006.40 |