- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,328.70 / $16,649.20 / $25,705.00
| Facility | | $11,328.70 | $16,649.20 | $25,705.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,636.43 / $23,651.17 / $30,322.01
| Facility | | $16,636.43 | $23,651.17 | $30,322.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,750.08 / $24,651.08 / $31,179.16
| Facility | | $12,750.08 | $24,651.08 | $31,179.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,328.70 / $17,029.30 / $27,230.60
| Facility | | $11,328.70 | $17,029.30 | $27,230.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,248.81 / $22,655.63 / $34,420.49
| Facility | | $13,248.81 | $22,655.63 | $34,420.49 |