- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,528.10 / $21,974.00 / $30,240.70
| Facility | | $13,528.10 | $21,974.00 | $30,240.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,752.21 / $16,752.21 / $16,752.21
| Facility | | $16,752.21 | $16,752.21 | $16,752.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,777.99 / $20,474.91 / $31,019.94
| Facility | | $12,777.99 | $20,474.91 | $31,019.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $18,283.93 / $31,301.12
| Facility | | $7,516.00 | $18,283.93 | $31,301.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $18,057.03 / $27,786.34
| Facility | | $7,516.00 | $18,057.03 | $27,786.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,264.00 / $23,907.28 / $34,342.01
| Facility | | $7,264.00 | $23,907.28 | $34,342.01 |