- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,967.00 / $13,076.90 / $21,227.90
| Facility | | $8,967.00 | $13,076.90 | $21,227.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,841.81 / $29,629.75 / $37,986.86
| Facility | | $20,841.81 | $29,629.75 | $37,986.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,529.37 / $20,357.54 / $25,748.61
| Facility | | $10,529.37 | $20,357.54 | $25,748.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,355.57 / $14,063.20 / $22,487.70
| Facility | | $9,355.57 | $14,063.20 | $22,487.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,941.23 / $18,709.65 / $28,425.39
| Facility | | $10,941.23 | $18,709.65 | $28,425.39 |