- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,730.20 / $15,538.20 / $27,186.00
| Facility | | $11,730.20 | $15,538.20 | $27,186.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,895.90 / $11,477.00 / $19,705.48
| Facility | | $8,895.90 | $11,477.00 | $19,705.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,923.36 / $13,723.72 / $26,801.24
| Facility | | $5,923.36 | $13,723.72 | $26,801.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,762.20 / $15,781.42 / $24,272.33
| Facility | | $10,762.20 | $15,781.42 | $24,272.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $16,012.87 / $24,457.68
| Facility | | $3,496.00 | $16,012.87 | $24,457.68 |