- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,060.70 / $21,628.00 / $39,307.50
| Facility | | $15,060.70 | $21,628.00 | $39,307.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,258.00 / $19,661.04 / $28,481.88
| Facility | | $11,258.00 | $19,661.04 | $28,481.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,148.34 / $19,214.57 / $30,312.84
| Facility | | $12,148.34 | $19,214.57 | $30,312.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,222.06 / $17,023.91 / $30,606.39
| Facility | | $9,222.06 | $17,023.91 | $30,606.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,553.00 / $20,068.55 / $27,604.70
| Facility | | $6,553.00 | $20,068.55 | $27,604.70 |