- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,237.80 / $16,886.20 / $28,261.40
| Facility | | $12,237.80 | $16,886.20 | $28,261.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,314.96 / $24,625.12 / $27,373.49
| Facility | | $8,314.96 | $24,625.12 | $27,373.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $19,348.28 / $29,799.49
| Facility | | $2,423.00 | $19,348.28 | $29,799.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,525.24 / $18,997.65 / $31,858.94
| Facility | | $12,525.24 | $18,997.65 | $31,858.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $15,332.15 / $34,092.82
| Facility | | $2,600.00 | $15,332.15 | $34,092.82 |