- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,210.00 / $13,431.30 / $21,803.10
| Facility | | $9,210.00 | $13,431.30 | $21,803.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,111.35 / $30,012.93 / $38,478.12
| Facility | | $21,111.35 | $30,012.93 | $38,478.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,814.70 / $20,909.22 / $26,446.38
| Facility | | $10,814.70 | $20,909.22 | $26,446.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,609.10 / $14,444.30 / $23,097.10
| Facility | | $9,609.10 | $14,444.30 | $23,097.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,237.74 / $19,216.66 / $29,195.70
| Facility | | $11,237.74 | $19,216.66 | $29,195.70 |