- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,959.70 / $17,167.00 / $30,035.70
| Facility | | $12,959.70 | $17,167.00 | $30,035.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,222.22 / $14,815.00 / $21,384.81
| Facility | | $12,222.22 | $14,815.00 | $21,384.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $14,999.65 / $29,606.69
| Facility | | $5,939.30 | $14,999.65 | $29,606.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,890.33 / $17,337.08 / $26,816.63
| Facility | | $11,890.33 | $17,337.08 | $26,816.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $17,691.39 / $27,021.41
| Facility | | $3,496.00 | $17,691.39 | $27,021.41 |