- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,372.46 / $13,774.20 / $21,266.20
| Facility | | $9,372.46 | $13,774.20 | $21,266.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,192.76 / $20,177.13 / $25,868.12
| Facility | | $14,192.76 | $20,177.13 | $25,868.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,548.39 / $20,394.32 / $25,795.12
| Facility | | $10,548.39 | $20,394.32 | $25,795.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,372.46 / $14,088.70 / $22,528.40
| Facility | | $9,372.46 | $14,088.70 | $22,528.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,961.00 / $18,743.45 / $28,476.74
| Facility | | $10,961.00 | $18,743.45 | $28,476.74 |