- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,419.60 / $19,086.20 / $27,024.00
| Facility | | $10,419.60 | $19,086.20 | $27,024.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,871.55 / $19,035.88 / $29,940.95
| Facility | | $11,871.55 | $19,035.88 | $29,940.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,833.24 / $17,169.04 / $30,546.45
| Facility | | $10,833.24 | $17,169.04 | $30,546.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,893.88 / $16,198.98 / $36,121.24
| Facility | | $6,893.88 | $16,198.98 | $36,121.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,846.08 / $32,099.22
| Facility | | $3,308.00 | $15,846.08 | $32,099.22 |