- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,448.00 / $20,969.90 / $29,691.20
| Facility | | $11,448.00 | $20,969.90 | $29,691.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,049.63 / $20,990.40 / $33,542.46
| Facility | | $13,049.63 | $20,990.40 | $33,542.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,902.44 / $18,863.56 / $33,561.26
| Facility | | $11,902.44 | $18,863.56 | $33,561.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $17,905.58 / $39,686.26
| Facility | | $7,117.00 | $17,905.58 | $39,686.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $17,410.02 / $35,267.29
| Facility | | $3,308.00 | $17,410.02 | $35,267.29 |