- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,697.30 / $23,258.30 / $32,931.30
| Facility | | $12,697.30 | $23,258.30 | $32,931.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,265.38 / $21,025.70 / $33,374.87
| Facility | | $13,265.38 | $21,025.70 | $33,374.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,201.32 / $20,922.09 / $37,223.72
| Facility | | $13,201.32 | $20,922.09 | $37,223.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,486.00 / $19,105.77 / $40,632.12
| Facility | | $5,486.00 | $19,105.77 | $40,632.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $17,701.77 / $36,911.71
| Facility | | $5,264.00 | $17,701.77 | $36,911.71 |