- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,416.40 / $16,778.00 / $25,903.80
| Facility | | $11,416.40 | $16,778.00 | $25,903.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,539.89 / $38,539.89 / $38,539.89
| Facility | | $38,539.89 | $38,539.89 | $38,539.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,115.02 / $21,488.26 / $27,549.05
| Facility | | $15,115.02 | $21,488.26 | $27,549.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,848.71 / $24,841.78 / $31,420.36
| Facility | | $12,848.71 | $24,841.78 | $31,420.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,416.40 / $17,161.00 / $27,441.20
| Facility | | $11,416.40 | $17,161.00 | $27,441.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,351.31 / $22,830.90 / $34,686.76
| Facility | | $13,351.31 | $22,830.90 | $34,686.76 |