- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,982.00 / $19,936.00 / $26,752.50
| Facility | | $11,982.00 | $19,936.00 | $26,752.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,440.62 / $13,803.12 / $20,637.87
| Facility | | $9,440.62 | $13,803.12 | $20,637.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,079.71 / $17,014.57 / $27,223.97
| Facility | | $10,079.71 | $17,014.57 | $27,223.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,868.45 / $16,051.50 / $36,812.51
| Facility | | $9,868.45 | $16,051.50 | $36,812.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,646.97 / $15,811.80 / $22,795.27
| Facility | | $11,646.97 | $15,811.80 | $22,795.27 |