- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,044.40 / $18,399.00 / $26,051.00
| Facility | | $10,044.40 | $18,399.00 | $26,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,493.74 / $18,640.96 / $29,980.94
| Facility | | $11,493.74 | $18,640.96 | $29,980.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,443.18 / $16,550.86 / $29,446.60
| Facility | | $10,443.18 | $16,550.86 | $29,446.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,645.66 / $15,922.06 / $34,820.66
| Facility | | $6,645.66 | $15,922.06 | $34,820.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,275.52 / $30,943.46
| Facility | | $3,308.00 | $15,275.52 | $30,943.46 |