- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,216.90 / $20,265.70 / $27,195.00
| Facility | | $12,216.90 | $20,265.70 | $27,195.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,372.08 / $12,372.08 / $12,372.08
| Facility | | $12,372.08 | $12,372.08 | $12,372.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,239.81 / $17,333.09 / $27,733.62
| Facility | | $10,239.81 | $17,333.09 | $27,733.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,031.69 / $16,317.00 / $37,421.41
| Facility | | $10,031.69 | $16,317.00 | $37,421.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,910.32 / $16,073.33 / $22,769.83
| Facility | | $11,910.32 | $16,073.33 | $22,769.83 |