- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,148.60 / $14,820.00 / $19,478.50
| Facility | | $10,148.60 | $14,820.00 | $19,478.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.37 / $11,766.37 / $11,766.37
| Facility | | $11,766.37 | $11,766.37 | $11,766.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,519.78 / $15,032.44 / $25,425.35
| Facility | | $5,519.78 | $15,032.44 | $25,425.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,309.58 / $14,885.83 / $24,915.51
| Facility | | $10,309.58 | $14,885.83 | $24,915.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,765.55 / $16,612.78 / $24,256.01
| Facility | | $12,765.55 | $16,612.78 | $24,256.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,765.55 / $15,443.79 / $24,256.01
| Facility | | $12,765.55 | $15,443.79 | $24,256.01 |