- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,505.80 / $17,855.50 / $28,584.00
| Facility | | $11,505.80 | $17,855.50 | $28,584.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,034.68 / $19,034.68 / $19,034.68
| Facility | | $19,034.68 | $19,034.68 | $19,034.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,068.11 / $13,749.82 / $19,512.56
| Facility | | $7,068.11 | $13,749.82 | $19,512.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,632.12 / $14,243.91 / $24,957.22
| Facility | | $10,632.12 | $14,243.91 | $24,957.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,439.87 / $16,131.36 / $21,616.51
| Facility | | $10,439.87 | $16,131.36 | $21,616.51 |