- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,785.10 / $20,261.50 / $33,638.90
| Facility | | $12,785.10 | $20,261.50 | $33,638.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,646.84 / $17,447.65 / $29,556.69
| Facility | | $11,646.84 | $17,447.65 | $29,556.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,942.00 / $21,611.26 / $30,944.70
| Facility | | $16,942.00 | $21,611.26 | $30,944.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,441.70 / $20,760.08 / $52,080.06
| Facility | | $10,441.70 | $20,760.08 | $52,080.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,441.70 / $20,714.91 / $29,113.80
| Facility | | $10,441.70 | $20,714.91 | $29,113.80 |