- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,924.30 / $16,054.90 / $24,787.40
| Facility | | $10,924.30 | $16,054.90 | $24,787.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,776.66 / $20,856.74 / $24,366.69
| Facility | | $17,776.66 | $20,856.74 | $24,366.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,730.59 / $23,785.05 / $30,493.66
| Facility | | $16,730.59 | $23,785.05 | $30,493.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,294.95 / $23,771.12 / $30,066.17
| Facility | | $12,294.95 | $23,771.12 | $30,066.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,924.30 / $16,421.40 / $26,258.50
| Facility | | $10,924.30 | $16,421.40 | $26,258.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,377.88 / $21,846.91 / $33,191.80
| Facility | | $14,377.88 | $21,846.91 | $33,191.80 |