- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,659.30 / $19,596.30 / $22,176.30
| Facility | | $12,659.30 | $19,596.30 | $22,176.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,569.34 / $19,010.75 / $25,675.47
| Facility | | $12,569.34 | $19,010.75 | $25,675.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,689.92 / $16,415.00 / $24,582.20
| Facility | | $11,689.92 | $16,415.00 | $24,582.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,068.00 / $18,281.00 / $23,441.00
| Facility | | $12,068.00 | $18,281.00 | $23,441.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $22,648.02 / $30,142.68
| Facility | | $5,274.00 | $22,648.02 | $30,142.68 |