- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,243.00 / $20,898.30 / $33,968.50
| Facility | | $12,243.00 | $20,898.30 | $33,968.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,021.60 / $20,342.95 / $27,702.46
| Facility | | $8,021.60 | $20,342.95 | $27,702.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,498.27 / $16,604.71 / $26,195.54
| Facility | | $10,498.27 | $16,604.71 | $26,195.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,263.01 / $10,340.76 / $26,419.14
| Facility | | $4,263.01 | $10,340.76 | $26,419.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,238.96 / $18,895.88 / $25,154.73
| Facility | | $12,238.96 | $18,895.88 | $25,154.73 |