- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,132.60 / $17,693.40 / $28,721.90
| Facility | | $12,132.60 | $17,693.40 | $28,721.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,431.22 / $30,467.67 / $39,061.12
| Facility | | $21,431.22 | $30,467.67 | $39,061.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,246.52 / $27,544.32 / $34,838.58
| Facility | | $14,246.52 | $27,544.32 | $34,838.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,658.30 / $19,028.00 / $30,426.50
| Facility | | $12,658.30 | $19,028.00 | $30,426.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,726.01 / $24,062.99 / $38,017.50
| Facility | | $13,726.01 | $24,062.99 | $38,017.50 |