- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,793.60 / $21,838.20 / $35,496.30
| Facility | | $12,793.60 | $21,838.20 | $35,496.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,640.00 / $11,258.00 / $19,368.75
| Facility | | $9,640.00 | $11,258.00 | $19,368.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,970.47 / $17,351.57 / $27,373.78
| Facility | | $10,970.47 | $17,351.57 | $27,373.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,174.54 / $17,090.66 / $32,000.72
| Facility | | $9,174.54 | $17,090.66 | $32,000.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $18,376.32 / $24,928.21
| Facility | | $6,289.00 | $18,376.32 | $24,928.21 |