- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,807.90 / $21,621.90 / $38,048.30
| Facility | | $12,807.90 | $21,621.90 | $38,048.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,460.85 / $22,325.91 / $36,423.62
| Facility | | $15,460.85 | $22,325.91 | $36,423.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,650.83 / $19,736.21 / $27,519.93
| Facility | | $11,650.83 | $19,736.21 | $27,519.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,901.25 / $39,752.65 / $46,653.11
| Facility | | $18,901.25 | $39,752.65 | $46,653.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $19,764.00 / $26,915.52
| Facility | | $1,787.00 | $19,764.00 | $26,915.52 |