- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,608.46 / $13,768.00 / $21,801.70
| Facility | | $9,608.46 | $13,768.00 | $21,801.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,289.79 / $17,471.77 / $22,399.70
| Facility | | $12,289.79 | $17,471.77 | $22,399.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,814.00 / $20,907.86 / $26,444.65
| Facility | | $10,814.00 | $20,907.86 | $26,444.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,608.46 / $14,443.40 / $23,095.60
| Facility | | $9,608.46 | $14,443.40 | $23,095.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,237.00 / $19,215.41 / $29,193.80
| Facility | | $11,237.00 | $19,215.41 | $29,193.80 |