- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,824.00 / $16,825.90 / $23,587.60
| Facility | | $10,824.00 | $16,825.90 | $23,587.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,058.26 / $22,058.26 / $22,058.26
| Facility | | $22,058.26 | $22,058.26 | $22,058.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,819.64 / $15,734.58 / $23,838.23
| Facility | | $9,819.64 | $15,734.58 | $23,838.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.21 / $14,261.38 / $24,414.71
| Facility | | $7,408.21 | $14,261.38 | $24,414.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.21 / $14,261.38 / $21,673.20
| Facility | | $7,408.21 | $14,261.38 | $21,673.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,964.46 / $18,494.89 / $26,521.71
| Facility | | $7,964.46 | $18,494.89 | $26,521.71 |