- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,556.60 / $16,876.00 / $22,180.90
| Facility | | $11,556.60 | $16,876.00 | $22,180.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,595.75 / $12,515.97 / $21,169.07
| Facility | | $4,595.75 | $12,515.97 | $21,169.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,739.87 / $16,951.00 / $28,372.14
| Facility | | $11,739.87 | $16,951.00 | $28,372.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,536.57 / $18,917.54 / $27,621.15
| Facility | | $14,536.57 | $18,917.54 | $27,621.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,536.57 / $17,586.37 / $27,621.15
| Facility | | $14,536.57 | $17,586.37 | $27,621.15 |