- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,446.79 / $12,513.60 / $21,894.00
| Facility | | $9,446.79 | $12,513.60 | $21,894.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,232.93 / $10,162.62 / $17,141.27
| Facility | | $7,232.93 | $10,162.62 | $17,141.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $11,883.57 / $21,791.13
| Facility | | $5,843.91 | $11,883.57 | $21,791.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,061.37 / $12,820.82 / $19,547.55
| Facility | | $9,061.37 | $12,820.82 | $19,547.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $12,895.85 / $19,696.82
| Facility | | $3,496.00 | $12,895.85 | $19,696.82 |