- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,474.00 / $21,017.60 / $29,758.70
| Facility | | $11,474.00 | $21,017.60 | $29,758.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,771.82 / $24,043.70 / $38,797.69
| Facility | | $14,771.82 | $24,043.70 | $38,797.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,929.50 / $23,366.00 / $33,637.58
| Facility | | $11,929.50 | $23,366.00 | $33,637.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $17,838.22 / $39,776.50
| Facility | | $7,117.00 | $17,838.22 | $39,776.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $16,880.24 / $35,347.47
| Facility | | $3,308.00 | $16,880.24 | $35,347.47 |