- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,855.40 / $15,280.00 / $31,053.10
| Facility | | $11,855.40 | $15,280.00 | $31,053.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,125.81 / $16,891.84 / $18,432.08
| Facility | | $13,125.81 | $16,891.84 | $18,432.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,746.24 / $14,724.16 / $16,833.52
| Facility | | $11,746.24 | $14,724.16 | $16,833.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,463.17 / $16,750.80 / $21,785.14
| Facility | | $9,463.17 | $16,750.80 | $21,785.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,094.68 / $19,425.62 / $20,681.07
| Facility | | $15,094.68 | $19,425.62 | $20,681.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $13,433.73 / $20,688.27
| Facility | | $1,286.00 | $13,433.73 | $20,688.27 |