- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,238.00 / $19,783.20 / $30,902.70
| Facility | | $15,238.00 | $19,783.20 | $30,902.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,085.97 / $15,085.97 / $15,085.97
| Facility | | $15,085.97 | $15,085.97 | $15,085.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,911.62 / $17,484.32 / $26,489.12
| Facility | | $10,911.62 | $17,484.32 | $26,489.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,176.97 / $17,302.37 / $26,801.43
| Facility | | $11,176.97 | $17,302.37 | $26,801.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.38 / $17,716.22 / $26,098.29
| Facility | | $12,302.38 | $17,716.22 | $26,098.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,403.00 / $20,470.49 / $28,781.34
| Facility | | $10,403.00 | $20,470.49 | $28,781.34 |