- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,701.20 / $20,798.40 / $36,389.40
| Facility | | $15,701.20 | $20,798.40 | $36,389.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,690.36 / $24,690.36 / $36,399.74
| Facility | | $24,690.36 | $24,690.36 | $36,399.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,707.53 / $17,161.43 / $34,478.16
| Facility | | $5,707.53 | $17,161.43 | $34,478.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,545.75 / $21,004.51 / $32,489.33
| Facility | | $13,545.75 | $21,004.51 | $32,489.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $21,433.77 / $36,817.30
| Facility | | $3,496.00 | $21,433.77 | $36,817.30 |