- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,120.90 / $16,911.09 / $34,367.90
| Facility | | $13,120.90 | $16,911.09 | $34,367.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,150.34 / $17,150.34 / $24,274.31
| Facility | | $17,150.34 | $17,150.34 | $24,274.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,853.13 / $16,111.67 / $18,419.80
| Facility | | $12,853.13 | $16,111.67 | $18,419.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,473.32 / $18,538.88 / $24,110.61
| Facility | | $10,473.32 | $18,538.88 | $24,110.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,915.46 / $27,915.46 / $27,915.46
| Facility | | $27,915.46 | $27,915.46 | $27,915.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $14,867.72 / $22,896.66
| Facility | | $1,286.00 | $14,867.72 | $22,896.66 |