- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,376.40 / $19,007.09 / $26,912.10
| Facility | | $10,376.40 | $19,007.09 | $26,912.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,440.23 / $16,892.56 / $26,611.14
| Facility | | $10,440.23 | $16,892.56 | $26,611.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,788.36 / $17,097.91 / $30,419.91
| Facility | | $10,788.36 | $17,097.91 | $30,419.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,865.32 / $15,780.43 / $35,971.60
| Facility | | $6,865.32 | $15,780.43 | $35,971.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,780.43 / $31,966.24
| Facility | | $3,308.00 | $15,780.43 | $31,966.24 |