- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,273.90 / $20,720.40 / $36,461.90
| Facility | | $12,273.90 | $20,720.40 | $36,461.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,735.67 / $23,234.04 / $37,832.74
| Facility | | $15,735.67 | $23,234.04 | $37,832.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,165.06 / $18,988.00 / $26,372.52
| Facility | | $11,165.06 | $18,988.00 | $26,372.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,554.85 / $38,554.85 / $45,247.39
| Facility | | $38,554.85 | $38,554.85 | $45,247.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $18,057.66 / $25,793.31
| Facility | | $1,787.00 | $18,057.66 | $25,793.31 |