- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,766.78 / $11,414.40 / $17,622.90
| Facility | | $7,766.78 | $11,414.40 | $17,622.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,374.74 / $14,669.69 / $19,278.46
| Facility | | $12,374.74 | $14,669.69 | $19,278.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,282.26 / $21,726.02 / $27,853.87
| Facility | | $15,282.26 | $21,726.02 | $27,853.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,741.24 / $16,900.37 / $21,375.91
| Facility | | $8,741.24 | $16,900.37 | $21,375.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,766.78 / $11,675.00 / $18,668.80
| Facility | | $7,766.78 | $11,675.00 | $18,668.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,083.16 / $15,532.32 / $23,598.11
| Facility | | $9,083.16 | $15,532.32 | $23,598.11 |