- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,210.60 / $20,535.00 / $29,075.40
| Facility | | $11,210.60 | $20,535.00 | $29,075.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,564.03 / $18,564.03 / $18,564.03
| Facility | | $18,564.03 | $18,564.03 | $18,564.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,940.42 / $19,355.46 / $30,635.58
| Facility | | $11,940.42 | $19,355.46 | $30,635.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,655.60 / $18,472.36 / $32,865.26
| Facility | | $11,655.60 | $18,472.36 | $32,865.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $17,127.46 / $38,863.23
| Facility | | $7,117.00 | $17,127.46 | $38,863.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,520.00 / $17,428.65 / $35,874.58
| Facility | | $6,520.00 | $17,428.65 | $35,874.58 |