- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,556.10 / $19,336.20 / $27,378.00
| Facility | | $10,556.10 | $19,336.20 | $27,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,285.55 / $11,285.55 / $11,285.55
| Facility | | $11,285.55 | $11,285.55 | $11,285.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,987.86 / $19,307.97 / $30,813.29
| Facility | | $11,987.86 | $19,307.97 | $30,813.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,975.14 / $17,393.93 / $30,946.57
| Facility | | $10,975.14 | $17,393.93 | $30,946.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,984.18 / $16,411.16 / $36,594.37
| Facility | | $6,984.18 | $16,411.16 | $36,594.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $16,411.16 / $32,519.67
| Facility | | $3,308.00 | $16,411.16 | $32,519.67 |