- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,372.40 / $16,607.00 / $21,827.40
| Facility | | $11,372.40 | $16,607.00 | $21,827.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,941.53 / $18,941.53 / $18,941.53
| Facility | | $18,941.53 | $18,941.53 | $18,941.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,352.80 / $14,577.69 / $24,656.20
| Facility | | $5,352.80 | $14,577.69 | $24,656.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,552.78 / $16,680.84 / $27,919.98
| Facility | | $11,552.78 | $16,680.84 | $27,919.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,304.90 / $18,616.05 / $27,180.95
| Facility | | $14,304.90 | $18,616.05 | $27,180.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,304.90 / $17,306.09 / $27,180.95
| Facility | | $14,304.90 | $17,306.09 | $27,180.95 |