- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,968.00 / $17,640.30 / $31,031.30
| Facility | | $9,968.00 | $17,640.30 | $31,031.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,231.00 / $17,398.40 / $23,656.39
| Facility | | $11,231.00 | $17,398.40 | $23,656.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,590.52 / $15,168.96 / $23,930.50
| Facility | | $9,590.52 | $15,168.96 | $23,930.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,076.75 / $10,861.53 / $24,134.77
| Facility | | $5,076.75 | $10,861.53 | $24,134.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,505.00 / $15,843.14 / $21,817.29
| Facility | | $6,505.00 | $15,843.14 | $21,817.29 |