- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,369.00 / $10,942.00 / $17,870.20
| Facility | | $2,369.00 | $10,942.00 | $17,870.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,081.77 / $19,111.49 / $25,209.84
| Facility | | $14,081.77 | $19,111.49 | $25,209.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,840.79 / $15,135.21 / $22,794.63
| Facility | | $11,840.79 | $15,135.21 | $22,794.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,308.48 / $18,059.16 / $22,766.71
| Facility | | $10,308.48 | $18,059.16 | $22,766.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,523.24 / $15,833.18 / $23,222.00
| Facility | | $10,523.24 | $15,833.18 | $23,222.00 |