- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,656.80 / $18,177.40 / $23,162.00
| Facility | | $11,656.80 | $18,177.40 | $23,162.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,493.49 / $34,493.49 / $34,493.49
| Facility | | $34,493.49 | $34,493.49 | $34,493.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,422.35 / $18,620.43 / $21,932.46
| Facility | | $10,422.35 | $18,620.43 | $21,932.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,921.67 / $18,884.07 / $26,455.20
| Facility | | $9,921.67 | $18,884.07 | $26,455.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,944.74 / $20,599.90 / $26,455.20
| Facility | | $17,944.74 | $20,599.90 | $26,455.20 |