- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,061.79 / $16,986.00 / $29,890.50
| Facility | | $10,061.79 | $16,986.00 | $29,890.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,980.78 / $20,686.56 / $34,221.25
| Facility | | $13,980.78 | $20,686.56 | $34,221.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,152.81 / $15,656.97 / $21,619.47
| Facility | | $9,152.81 | $15,656.97 | $21,619.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,308.05 / $30,308.05 / $35,569.07
| Facility | | $30,308.05 | $30,308.05 | $35,569.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $14,803.18 / $21,144.65
| Facility | | $1,787.00 | $14,803.18 | $21,144.65 |