- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,957.00 / $16,961.20 / $19,194.30
| Facility | | $10,957.00 | $16,961.20 | $19,194.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,361.11 / $17,183.34 / $23,207.42
| Facility | | $11,361.11 | $17,183.34 | $23,207.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,117.96 / $14,879.82 / $21,430.00
| Facility | | $10,117.96 | $14,879.82 | $21,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,160.00 / $16,607.00 / $20,738.00
| Facility | | $11,160.00 | $16,607.00 | $20,738.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $19,602.52 / $26,089.37
| Facility | | $5,274.00 | $19,602.52 | $26,089.37 |