- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,490.00 / $16,609.30 / $26,961.10
| Facility | | $8,490.00 | $16,609.30 | $26,961.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,160.46 / $28,432.80 / $36,868.58
| Facility | | $19,160.46 | $28,432.80 | $36,868.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,647.00 / $21,636.63 / $34,594.69
| Facility | | $14,647.00 | $21,636.63 | $34,594.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,130.45 / $23,308.95 / $48,879.60
| Facility | | $12,130.45 | $23,308.95 | $48,879.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,112.27 / $23,155.02 / $34,603.24
| Facility | | $17,112.27 | $23,155.02 | $34,603.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $16,763.00 / $29,760.93
| Facility | | $4,870.00 | $16,763.00 | $29,760.93 |