- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,683.00 / $19,568.80 / $27,707.30
| Facility | | $10,683.00 | $19,568.80 | $27,707.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,835.60 / $19,189.03 / $30,388.96
| Facility | | $11,835.60 | $19,189.03 | $30,388.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,107.14 / $17,603.13 / $31,318.77
| Facility | | $11,107.14 | $17,603.13 | $31,318.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,068.18 / $16,608.54 / $37,034.50
| Facility | | $7,068.18 | $16,608.54 | $37,034.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $16,246.72 / $32,910.79
| Facility | | $3,308.00 | $16,246.72 | $32,910.79 |