- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,970.10 / $21,895.60 / $38,530.00
| Facility | | $12,970.10 | $21,895.60 | $38,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,809.59 / $16,818.09 / $27,552.68
| Facility | | $11,809.59 | $16,818.09 | $27,552.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,755.80 / $19,963.37 / $27,868.29
| Facility | | $11,755.80 | $19,963.37 | $27,868.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,008.75 / $41,008.75 / $48,127.25
| Facility | | $41,008.75 | $41,008.75 | $48,127.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $19,081.84 / $27,256.22
| Facility | | $1,787.00 | $19,081.84 | $27,256.22 |