- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,370.30 / $19,290.00 / $24,579.70
| Facility | | $12,370.30 | $19,290.00 | $24,579.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,923.41 / $17,923.41 / $17,923.41
| Facility | | $17,923.41 | $17,923.41 | $17,923.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,892.56 / $19,760.16 / $23,274.90
| Facility | | $10,892.56 | $19,760.16 | $23,274.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,528.95 / $20,039.91 / $28,074.47
| Facility | | $10,528.95 | $20,039.91 | $28,074.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,043.09 / $21,860.77 / $28,074.47
| Facility | | $19,043.09 | $21,860.77 | $28,074.47 |