- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,346.00 / $20,480.00 / $27,482.50
| Facility | | $12,346.00 | $20,480.00 | $27,482.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,813.62 / $17,925.62 / $18,001.87
| Facility | | $11,813.62 | $17,925.62 | $18,001.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,873.36 / $17,292.50 / $27,668.67
| Facility | | $9,873.36 | $17,292.50 | $27,668.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,137.74 / $16,489.50 / $37,817.01
| Facility | | $10,137.74 | $16,489.50 | $37,817.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,036.24 / $16,243.26 / $23,010.55
| Facility | | $12,036.24 | $16,243.26 | $23,010.55 |