- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,703.20 / $21,072.40 / $28,277.50
| Facility | | $12,703.20 | $21,072.40 | $28,277.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,716.65 / $9,716.65 / $14,911.86
| Facility | | $9,716.65 | $9,716.65 | $14,911.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,172.61 / $17,607.90 / $28,173.32
| Facility | | $10,172.61 | $17,607.90 | $28,173.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,431.00 / $16,966.50 / $38,910.97
| Facility | | $10,431.00 | $16,966.50 | $38,910.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,347.19 / $16,713.13 / $23,676.19
| Facility | | $12,347.19 | $16,713.13 | $23,676.19 |