- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,712.67 / $13,649.20 / $22,660.90
| Facility | | $9,712.67 | $13,649.20 | $22,660.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,781.37 / $13,155.02 / $22,284.89
| Facility | | $8,781.37 | $13,155.02 | $22,284.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,765.19 / $14,920.05 / $22,744.00
| Facility | | $11,765.19 | $14,920.05 | $22,744.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,313.75 / $14,615.80 / $39,266.86
| Facility | | $7,313.75 | $14,615.80 | $39,266.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,313.75 / $13,954.64 / $19,612.55
| Facility | | $7,313.75 | $13,954.64 | $19,612.55 |