- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,790.00 / $23,428.10 / $33,171.69
| Facility | | $12,790.00 | $23,428.10 | $33,171.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,571.90 / $13,955.35 / $22,518.80
| Facility | | $8,571.90 | $13,955.35 | $22,518.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,297.68 / $21,074.81 / $37,495.43
| Facility | | $13,297.68 | $21,074.81 | $37,495.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $16,201.01 / $37,181.14
| Facility | | $7,117.00 | $16,201.01 | $37,181.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $19,450.88 / $39,401.43
| Facility | | $3,308.00 | $19,450.88 | $39,401.43 |