- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,862.00 / $15,861.80 / $20,847.80
| Facility | | $10,862.00 | $15,861.80 | $20,847.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,205.50 / $11,453.17 / $19,371.49
| Facility | | $4,205.50 | $11,453.17 | $19,371.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,034.31 / $15,932.25 / $26,666.98
| Facility | | $11,034.31 | $15,932.25 | $26,666.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,662.92 / $17,780.59 / $25,961.12
| Facility | | $13,662.92 | $17,780.59 | $25,961.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,662.92 / $16,529.43 / $25,961.12
| Facility | | $13,662.92 | $16,529.43 | $25,961.12 |