- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,744.18 / $17,849.00 / $25,272.20
| Facility | | $9,744.18 | $17,849.00 | $25,272.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,416.40 / $18,363.33 / $29,344.44
| Facility | | $11,416.40 | $18,363.33 | $29,344.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,131.00 / $16,056.10 / $28,566.35
| Facility | | $10,131.00 | $16,056.10 | $28,566.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,447.00 / $15,148.92 / $33,779.76
| Facility | | $6,447.00 | $15,148.92 | $33,779.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $14,818.89 / $30,018.46
| Facility | | $3,308.00 | $14,818.89 | $30,018.46 |