- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,823.10 / $18,737.00 / $31,107.90
| Facility | | $11,823.10 | $18,737.00 | $31,107.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,756.73 / $17,612.27 / $29,835.56
| Facility | | $11,756.73 | $17,612.27 | $29,835.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,150.75 / $19,985.22 / $28,736.31
| Facility | | $16,150.75 | $19,985.22 | $28,736.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,656.07 / $19,198.09 / $52,571.44
| Facility | | $9,656.07 | $19,198.09 | $52,571.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,656.07 / $19,156.32 / $26,923.26
| Facility | | $9,656.07 | $19,156.32 | $26,923.26 |