- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,364.40 / $18,985.00 / $26,880.80
| Facility | | $10,364.40 | $18,985.00 | $26,880.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,376.77 / $16,447.24 / $26,107.31
| Facility | | $10,376.77 | $16,447.24 | $26,107.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,363.00 / $16,336.80 / $30,384.55
| Facility | | $8,363.00 | $16,336.80 | $30,384.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,857.34 / $15,764.50 / $35,929.78
| Facility | | $6,857.34 | $15,764.50 | $35,929.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,762.09 / $31,929.08
| Facility | | $3,308.00 | $15,762.09 | $31,929.08 |