- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,950.70 / $22,564.70 / $30,401.30
| Facility | | $13,950.70 | $22,564.70 | $30,401.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,829.81 / $17,829.81 / $17,829.81
| Facility | | $17,829.81 | $17,829.81 | $17,829.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,247.07 / $19,624.18 / $29,731.07
| Facility | | $12,247.07 | $19,624.18 | $29,731.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,122.81 / $20,314.61 / $31,467.40
| Facility | | $13,122.81 | $20,314.61 | $31,467.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,943.43 / $20,314.61 / $29,779.04
| Facility | | $11,943.43 | $20,314.61 | $29,779.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,403.00 / $23,196.31 / $32,694.87
| Facility | | $10,403.00 | $23,196.31 | $32,694.87 |