- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,993.66 / $18,306.00 / $25,919.30
| Facility | | $9,993.66 | $18,306.00 | $25,919.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,033.52 / $17,894.55 / $28,780.47
| Facility | | $11,033.52 | $17,894.55 | $28,780.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,390.37 / $16,467.18 / $29,297.72
| Facility | | $10,390.37 | $16,467.18 | $29,297.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,612.06 / $15,536.77 / $34,644.61
| Facility | | $6,612.06 | $15,536.77 | $34,644.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,198.29 / $30,787.01
| Facility | | $3,308.00 | $15,198.29 | $30,787.01 |