- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,803.60 / $16,723.80 / $18,925.70
| Facility | | $10,803.60 | $16,723.80 | $18,925.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,769.26 / $16,288.19 / $21,998.44
| Facility | | $10,769.26 | $16,288.19 | $21,998.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,976.37 / $15,394.60 / $20,978.86
| Facility | | $9,976.37 | $15,394.60 | $20,978.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,654.00 / $15,888.00 / $20,738.00
| Facility | | $10,654.00 | $15,888.00 | $20,738.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $19,328.20 / $25,724.28
| Facility | | $5,274.00 | $19,328.20 | $25,724.28 |