- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,047.60 / $16,962.00 / $29,848.30
| Facility | | $10,047.60 | $16,962.00 | $29,848.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,610.84 / $15,662.64 / $25,316.03
| Facility | | $10,610.84 | $15,662.64 | $25,316.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,139.87 / $15,634.87 / $21,588.94
| Facility | | $9,139.87 | $15,634.87 | $21,588.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,397.20 / $31,397.20 / $36,847.28
| Facility | | $31,397.20 | $31,397.20 | $36,847.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $14,782.28 / $21,114.79
| Facility | | $1,787.00 | $14,782.28 | $21,114.79 |