- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,884.40 / $28,008.30 / $37,585.00
| Facility | | $16,884.40 | $28,008.30 | $37,585.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,124.40 / $21,124.40 / $21,609.94
| Facility | | $21,124.40 | $21,124.40 | $21,609.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,375.50 / $22,577.84 / $36,125.41
| Facility | | $13,375.50 | $22,577.84 | $36,125.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,864.35 / $22,551.00 / $51,718.46
| Facility | | $13,864.35 | $22,551.00 | $51,718.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,363.01 / $22,214.24 / $31,469.17
| Facility | | $16,363.01 | $22,214.24 | $31,469.17 |