- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,625.00 / $16,778.09 / $27,236.20
| Facility | | $11,625.00 | $16,778.09 | $27,236.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,403.36 / $19,403.36 / $19,403.36
| Facility | | $19,403.36 | $19,403.36 | $19,403.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,455.40 / $17,707.22 / $22,701.56
| Facility | | $12,455.40 | $17,707.22 | $22,701.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,509.57 / $26,119.49 / $33,036.43
| Facility | | $13,509.57 | $26,119.49 | $33,036.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,003.50 / $18,043.70 / $28,852.60
| Facility | | $12,003.50 | $18,043.70 | $28,852.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,038.02 / $24,005.18 / $36,470.85
| Facility | | $14,038.02 | $24,005.18 | $36,470.85 |