- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,502.10 / $19,237.40 / $27,238.00
| Facility | | $10,502.10 | $19,237.40 | $27,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,910.79 / $19,910.79 / $19,910.79
| Facility | | $19,910.79 | $19,910.79 | $19,910.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,202.63 / $18,028.78 / $28,794.98
| Facility | | $11,202.63 | $18,028.78 | $28,794.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,919.04 / $17,305.02 / $30,788.38
| Facility | | $10,919.04 | $17,305.02 | $30,788.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,948.48 / $16,327.27 / $36,407.32
| Facility | | $6,948.48 | $16,327.27 | $36,407.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,971.58 / $32,353.45
| Facility | | $3,308.00 | $15,971.58 | $32,353.45 |