- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,061.60 / $13,328.00 / $23,318.90
| Facility | | $10,061.60 | $13,328.00 | $23,318.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,450.75 / $11,053.89 / $17,328.58
| Facility | | $9,450.75 | $11,053.89 | $17,328.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,086.43 / $23,384.14
| Facility | | $5,843.91 | $12,086.43 | $23,384.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,547.62 / $13,536.59 / $20,819.70
| Facility | | $9,547.62 | $13,536.59 | $20,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $13,735.11 / $20,978.69
| Facility | | $3,496.00 | $13,735.11 | $20,978.69 |