- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,796.00 / $15,203.40 / $30,897.30
| Facility | | $11,796.00 | $15,203.40 | $30,897.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,250.93 / $18,250.93 / $18,250.93
| Facility | | $18,250.93 | $18,250.93 | $18,250.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,680.21 / $14,641.39 / $16,738.89
| Facility | | $11,680.21 | $14,641.39 | $16,738.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,415.69 / $16,666.75 / $21,675.84
| Facility | | $9,415.69 | $16,666.75 | $21,675.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,988.57 / $20,988.57 / $20,988.57
| Facility | | $20,988.57 | $20,988.57 | $20,988.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $13,366.33 / $20,584.48
| Facility | | $1,286.00 | $13,366.33 | $20,584.48 |