- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,988.79 / $14,567.00 / $23,646.80
| Facility | | $9,988.79 | $14,567.00 | $23,646.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,028.94 / $32,739.07 / $41,973.17
| Facility | | $23,028.94 | $32,739.07 | $41,973.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,729.20 / $22,677.31 / $28,682.69
| Facility | | $11,729.20 | $22,677.31 | $28,682.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,421.60 / $15,665.80 / $25,050.20
| Facility | | $10,421.60 | $15,665.80 | $25,050.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,188.00 / $20,841.63 / $31,664.50
| Facility | | $12,188.00 | $20,841.63 | $31,664.50 |