- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,745.80 / $19,368.09 / $32,155.60
| Facility | | $14,745.80 | $19,368.09 | $32,155.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,562.68 / $17,700.63 / $29,916.68
| Facility | | $11,562.68 | $17,700.63 | $29,916.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,881.02 / $20,658.28 / $30,625.00
| Facility | | $15,881.02 | $20,658.28 | $30,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,981.27 / $19,844.64 / $51,703.75
| Facility | | $9,981.27 | $19,844.64 | $51,703.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,378.12 / $19,595.56 / $27,829.98
| Facility | | $10,378.12 | $19,595.56 | $27,829.98 |