- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,937.60 / $25,008.90 / $40,267.60
| Facility | | $10,937.60 | $25,008.90 | $40,267.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $12,562.60 / $32,786.92
| Facility | | $1,474.01 | $12,562.60 | $32,786.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,046.00 / $24,767.73 / $37,042.43
| Facility | | $17,046.00 | $24,767.73 | $37,042.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,857.31 / $21,931.43 / $46,058.71
| Facility | | $14,857.31 | $21,931.43 | $46,058.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,857.31 / $24,887.00 / $39,539.79
| Facility | | $14,857.31 | $24,887.00 | $39,539.79 |