- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,841.20 / $20,417.09 / $41,493.00
| Facility | | $15,841.20 | $20,417.09 | $41,493.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,856.75 / $18,623.25 / $21,291.19
| Facility | | $14,856.75 | $18,623.25 | $21,291.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,534.10 / $20,826.06 / $28,627.27
| Facility | | $12,534.10 | $20,826.06 | $28,627.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,047.40 / $27,047.40 / $27,047.40
| Facility | | $27,047.40 | $27,047.40 | $27,047.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $17,950.07 / $27,643.55
| Facility | | $1,286.00 | $17,950.07 | $27,643.55 |