- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,351.00 / $13,636.90 / $22,136.90
| Facility | | $9,351.00 | $13,636.90 | $22,136.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,238.82 / $24,507.56 / $31,419.95
| Facility | | $17,238.82 | $24,507.56 | $31,419.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,980.27 / $21,229.33 / $26,851.26
| Facility | | $10,980.27 | $21,229.33 | $26,851.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,756.20 / $14,665.50 / $23,450.80
| Facility | | $9,756.20 | $14,665.50 | $23,450.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,409.78 / $19,510.86 / $29,642.67
| Facility | | $11,409.78 | $19,510.86 | $29,642.67 |