- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,524.29 / $12,448.00 / $16,360.90
| Facility | | $8,524.29 | $12,448.00 | $16,360.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,181.10 / $11,386.74 / $19,259.14
| Facility | | $4,181.10 | $11,386.74 | $19,259.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,659.51 / $12,503.31 / $20,927.72
| Facility | | $8,659.51 | $12,503.31 | $20,927.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,722.39 / $13,953.86 / $20,373.78
| Facility | | $10,722.39 | $13,953.86 | $20,373.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,722.39 / $12,971.98 / $20,373.78
| Facility | | $10,722.39 | $12,971.98 | $20,373.78 |