- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,782.00 / $15,723.80 / $25,524.60
| Facility | | $10,782.00 | $15,723.80 | $25,524.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,285.91 / $24,574.50 / $31,505.77
| Facility | | $17,285.91 | $24,574.50 | $31,505.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,660.60 / $24,478.09 / $30,960.35
| Facility | | $12,660.60 | $24,478.09 | $30,960.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,249.20 / $16,909.80 / $27,039.50
| Facility | | $11,249.20 | $16,909.80 | $27,039.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,805.48 / $22,496.64 / $34,178.94
| Facility | | $14,805.48 | $22,496.64 | $34,178.94 |