- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,838.40 / $15,806.00 / $25,658.10
| Facility | | $10,838.40 | $15,806.00 | $25,658.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,064.69 / $21,416.70 / $27,457.31
| Facility | | $15,064.69 | $21,416.70 | $27,457.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,726.83 / $24,817.77 / $36,050.32
| Facility | | $12,726.83 | $24,817.77 | $36,050.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,308.10 / $16,998.20 / $27,180.90
| Facility | | $11,308.10 | $16,998.20 | $27,180.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,224.65 / $22,614.32 / $34,357.73
| Facility | | $13,224.65 | $22,614.32 | $34,357.73 |