- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,865.70 / $21,735.10 / $30,774.50
| Facility | | $11,865.70 | $21,735.10 | $30,774.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,188.47 / $19,753.00 / $31,264.83
| Facility | | $12,188.47 | $19,753.00 | $31,264.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,336.72 / $19,551.83 / $34,785.81
| Facility | | $12,336.72 | $19,551.83 | $34,785.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $18,045.25 / $41,134.29
| Facility | | $7,117.00 | $18,045.25 | $41,134.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $18,045.25 / $36,554.08
| Facility | | $3,308.00 | $18,045.25 | $36,554.08 |