- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,049.29 / $21,100.30 / $29,853.30
| Facility | | $10,049.29 | $21,100.30 | $29,853.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,989.70 / $13,301.55 / $21,791.60
| Facility | | $8,989.70 | $13,301.55 | $21,791.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,141.41 / $15,637.47 / $21,592.53
| Facility | | $9,141.41 | $15,637.47 | $21,592.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,501.50 / $30,501.50 / $35,796.10
| Facility | | $30,501.50 | $30,501.50 | $35,796.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $14,784.74 / $21,118.31
| Facility | | $1,787.00 | $14,784.74 | $21,118.31 |