- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,003.20 / $18,323.40 / $25,944.00
| Facility | | $10,003.20 | $18,323.40 | $25,944.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,125.92 / $16,076.06 / $25,495.79
| Facility | | $10,125.92 | $16,076.06 | $25,495.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,708.00 / $15,767.45 / $29,325.64
| Facility | | $8,708.00 | $15,767.45 | $29,325.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,618.36 / $15,126.95 / $34,677.62
| Facility | | $6,618.36 | $15,126.95 | $34,677.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,212.77 / $30,816.34
| Facility | | $3,308.00 | $15,212.77 | $30,816.34 |