- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,958.20 / $17,462.50 / $22,951.80
| Facility | | $11,958.20 | $17,462.50 | $22,951.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,173.60 / $11,366.31 / $19,224.57
| Facility | | $4,173.60 | $11,366.31 | $19,224.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,147.88 / $17,540.12 / $29,358.19
| Facility | | $12,147.88 | $17,540.12 | $29,358.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,041.78 / $19,575.00 / $28,581.10
| Facility | | $15,041.78 | $19,575.00 | $28,581.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,041.78 / $18,197.58 / $28,581.10
| Facility | | $15,041.78 | $18,197.58 | $28,581.10 |