- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,811.00 / $15,787.20 / $20,749.80
| Facility | | $10,811.00 | $15,787.20 | $20,749.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,464.42 / $12,257.28 / $20,564.11
| Facility | | $4,464.42 | $12,257.28 | $20,564.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,982.46 / $15,857.39 / $26,541.68
| Facility | | $10,982.46 | $15,857.39 | $26,541.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,598.73 / $17,697.05 / $25,839.14
| Facility | | $13,598.73 | $17,697.05 | $25,839.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,598.73 / $16,451.77 / $25,839.14
| Facility | | $13,598.73 | $16,451.77 | $25,839.14 |