- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,988.50 / $15,880.40 / $27,784.80
| Facility | | $11,988.50 | $15,880.40 | $27,784.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,791.87 / $14,815.00 / $20,337.68
| Facility | | $8,791.87 | $14,815.00 | $20,337.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $14,141.32 / $27,616.78
| Facility | | $5,939.30 | $14,141.32 | $27,616.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,999.24 / $16,129.01 / $24,806.93
| Facility | | $10,999.24 | $16,129.01 | $24,806.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $16,365.55 / $24,996.36
| Facility | | $3,496.00 | $16,365.55 | $24,996.36 |