- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $21,877.62 / $38,018.94
| Facility | | $17,378.01 | $21,877.62 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,113.11 / $33,113.11 / $33,113.11
| Facility | | $33,113.11 | $33,113.11 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $21,877.62 / $35,481.34
| Facility | | $13,182.57 | $21,877.62 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $29,512.09 / $38,018.94
| Facility | | $18,620.87 | $29,512.09 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $28,840.32 / $44,668.36
| Facility | | $16,218.10 | $28,840.32 | $44,668.36 |