- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,579.62 / $16,172.00 / $28,458.00
| Facility | | $9,579.62 | $16,172.00 | $28,458.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,703.15 / $12,850.38 / $21,129.04
| Facility | | $8,703.15 | $12,850.38 | $21,129.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,714.17 / $14,906.63 / $20,583.39
| Facility | | $8,714.17 | $14,906.63 | $20,583.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,273.60 / $30,273.60 / $35,528.64
| Facility | | $30,273.60 | $30,273.60 | $35,528.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $14,093.76 / $20,131.32
| Facility | | $1,787.00 | $14,093.76 | $20,131.32 |