- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,174.40 / $11,921.00 / $19,351.50
| Facility | | $8,174.40 | $11,921.00 | $19,351.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,531.89 / $30,610.79 / $39,244.60
| Facility | | $21,531.89 | $30,610.79 | $39,244.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,598.67 / $18,558.12 / $23,472.67
| Facility | | $9,598.67 | $18,558.12 | $23,472.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,528.62 / $12,820.20 / $20,500.00
| Facility | | $8,528.62 | $12,820.20 | $20,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,974.12 / $17,055.89 / $25,912.85
| Facility | | $9,974.12 | $17,055.89 | $25,912.85 |