- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,140.40 / $17,406.20 / $30,454.30
| Facility | | $13,140.40 | $17,406.20 | $30,454.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,484.77 / $15,484.77 / $19,796.73
| Facility | | $15,484.77 | $15,484.77 | $19,796.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,707.53 / $14,256.22 / $29,144.55
| Facility | | $5,707.53 | $14,256.22 | $29,144.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,986.94 / $17,470.00 / $27,190.35
| Facility | | $11,986.94 | $17,470.00 | $27,190.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $17,937.93 / $27,397.99
| Facility | | $3,496.00 | $17,937.93 | $27,397.99 |