- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,323.20 / $16,513.00 / $26,805.80
| Facility | | $11,323.20 | $16,513.00 | $26,805.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,530.89 / $23,501.13 / $30,129.65
| Facility | | $16,530.89 | $23,501.13 | $30,129.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,296.10 / $25,706.76 / $32,514.40
| Facility | | $13,296.10 | $25,706.76 | $32,514.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,813.90 / $17,758.59 / $28,396.70
| Facility | | $11,813.90 | $17,758.59 | $28,396.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,548.64 / $23,625.86 / $35,894.54
| Facility | | $15,548.64 | $23,625.86 | $35,894.54 |