- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,341.60 / $20,834.70 / $36,663.00
| Facility | | $12,341.60 | $20,834.70 | $36,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,836.86 / $26,836.86 / $26,836.86
| Facility | | $26,836.86 | $26,836.86 | $26,836.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,269.58 / $18,408.58 / $30,032.68
| Facility | | $12,269.58 | $18,408.58 | $30,032.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,226.63 / $19,082.84 / $26,517.97
| Facility | | $11,226.63 | $19,082.84 | $26,517.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,952.35 / $38,952.35 / $45,713.89
| Facility | | $38,952.35 | $38,952.35 | $45,713.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $18,157.25 / $25,935.56
| Facility | | $1,787.00 | $18,157.25 | $25,935.56 |