- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,249.20 / $17,550.40 / $30,706.60
| Facility | | $13,249.20 | $17,550.40 | $30,706.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,569.61 / $14,348.99 / $23,091.66
| Facility | | $10,569.61 | $14,348.99 | $23,091.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $15,778.96 / $30,528.24
| Facility | | $5,939.30 | $15,778.96 | $30,528.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,155.90 / $17,470.00 / $27,415.58
| Facility | | $12,155.90 | $17,470.00 | $27,415.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $18,086.53 / $27,624.93
| Facility | | $3,496.00 | $18,086.53 | $27,624.93 |