- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,540.10 / $17,863.80 / $20,215.70
| Facility | | $11,540.10 | $17,863.80 | $20,215.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,704.41 / $17,702.58 / $23,908.67
| Facility | | $11,704.41 | $17,702.58 | $23,908.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,656.42 / $15,866.00 / $22,408.90
| Facility | | $10,656.42 | $15,866.00 | $22,408.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,347.00 / $17,701.00 / $21,553.00
| Facility | | $11,347.00 | $17,701.00 | $21,553.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $20,800.38 / $27,477.78
| Facility | | $5,274.00 | $20,800.38 | $27,477.78 |