- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,986.00 / $16,021.30 / $26,007.50
| Facility | | $10,986.00 | $16,021.30 | $26,007.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,857.71 / $22,857.71 / $22,857.71
| Facility | | $22,857.71 | $22,857.71 | $22,857.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,663.41 / $30,797.76 / $39,484.31
| Facility | | $21,663.41 | $30,797.76 | $39,484.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,900.15 / $24,941.22 / $31,546.13
| Facility | | $12,900.15 | $24,941.22 | $31,546.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,462.10 / $17,229.70 / $27,551.10
| Facility | | $11,462.10 | $17,229.70 | $27,551.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,404.75 / $22,922.29 / $34,825.62
| Facility | | $13,404.75 | $22,922.29 | $34,825.62 |