- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,947.80 / $17,151.09 / $30,008.00
| Facility | | $12,947.80 | $17,151.09 | $30,008.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,503.57 / $8,503.57 / $9,630.62
| Facility | | $8,503.57 | $8,503.57 | $9,630.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $14,010.33 / $29,389.21
| Facility | | $5,939.30 | $14,010.33 | $29,389.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,879.36 / $17,321.08 / $26,791.88
| Facility | | $11,879.36 | $17,321.08 | $26,791.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $17,675.06 / $26,996.47
| Facility | | $3,496.00 | $17,675.06 | $26,996.47 |