- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,187.70 / $25,288.00 / $33,921.69
| Facility | | $12,187.70 | $25,288.00 | $33,921.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,590.40 / $24,926.24 / $34,343.33
| Facility | | $8,590.40 | $24,926.24 | $34,343.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.00 / $24,858.08 / $29,557.42
| Facility | | $2,651.00 | $24,858.08 | $29,557.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,494.83 / $26,112.65 / $41,100.51
| Facility | | $21,494.83 | $26,112.65 | $41,100.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,888.00 / $32,926.68
| Facility | | $1,500.00 | $5,888.00 | $32,926.68 |