- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,475.20 / $20,859.30 / $23,605.60
| Facility | | $13,475.20 | $20,859.30 | $23,605.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,440.96 / $20,329.06 / $27,959.99
| Facility | | $13,440.96 | $20,329.06 | $27,959.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,443.34 / $17,140.14 / $26,166.53
| Facility | | $12,443.34 | $17,140.14 | $26,166.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,756.00 / $19,082.00 / $25,000.00
| Facility | | $12,756.00 | $19,082.00 | $25,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $21,253.70 / $32,008.34
| Facility | | $5,274.00 | $21,253.70 | $32,008.34 |