- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,157.30 / $20,167.00 / $27,062.50
| Facility | | $12,157.30 | $20,167.00 | $27,062.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,873.14 / $15,873.14 / $34,064.19
| Facility | | $15,873.14 | $15,873.14 | $34,064.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,578.79 / $16,880.29 / $27,009.12
| Facility | | $9,578.79 | $16,880.29 | $27,009.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,982.82 / $16,237.50 / $37,239.08
| Facility | | $9,982.82 | $16,237.50 | $37,239.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,836.96 / $15,995.02 / $22,658.89
| Facility | | $11,836.96 | $15,995.02 | $22,658.89 |