- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,801.40 / $19,816.30 / $22,425.30
| Facility | | $12,801.40 | $19,816.30 | $22,425.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,570.45 / $19,012.45 / $25,677.75
| Facility | | $12,570.45 | $19,012.45 | $25,677.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,821.17 / $16,507.00 / $24,858.21
| Facility | | $11,821.17 | $16,507.00 | $24,858.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,733.07 / $18,998.00 / $23,909.00
| Facility | | $12,733.07 | $18,998.00 | $23,909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $22,902.31 / $30,481.13
| Facility | | $5,274.00 | $22,902.31 | $30,481.13 |