- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,105.40 / $25,057.30 / $33,625.00
| Facility | | $15,105.40 | $25,057.30 | $33,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,505.09 / $13,505.09 / $27,570.09
| Facility | | $13,505.09 | $13,505.09 | $27,570.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,332.10 / $20,816.58 / $33,307.33
| Facility | | $12,332.10 | $20,816.58 | $33,307.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,403.59 / $20,175.00 / $46,269.35
| Facility | | $12,403.59 | $20,175.00 | $46,269.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,726.41 / $19,522.68 / $27,918.17
| Facility | | $14,726.41 | $19,522.68 | $27,918.17 |