- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,757.30 / $21,802.30 / $36,197.10
| Facility | | $13,757.30 | $21,802.30 | $36,197.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,206.02 / $18,685.48 / $30,975.75
| Facility | | $12,206.02 | $18,685.48 | $30,975.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,030.28 / $22,206.10 / $33,437.44
| Facility | | $17,030.28 | $22,206.10 | $33,437.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,682.50 / $22,290.21 / $37,425.12
| Facility | | $11,682.50 | $22,290.21 | $37,425.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,235.76 / $21,593.00 / $31,327.79
| Facility | | $11,235.76 | $21,593.00 | $31,327.79 |