- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,581.23 / $15,718.70 / $22,256.00
| Facility | | $8,581.23 | $15,718.70 | $22,256.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,026.85 / $16,176.34 / $25,463.76
| Facility | | $10,026.85 | $16,176.34 | $25,463.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,921.87 / $14,139.83 / $25,157.00
| Facility | | $8,921.87 | $14,139.83 | $25,157.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,677.56 / $13,716.71 / $29,748.20
| Facility | | $5,677.56 | $13,716.71 | $29,748.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $13,050.28 / $26,435.80
| Facility | | $3,308.00 | $13,050.28 | $26,435.80 |