- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,521.90 / $22,430.50 / $30,100.00
| Facility | | $13,521.90 | $22,430.50 | $30,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,517.03 / $21,517.03 / $21,517.03
| Facility | | $21,517.03 | $21,517.03 | $21,517.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,635.26 / $17,860.00 / $28,573.05
| Facility | | $10,635.26 | $17,860.00 | $28,573.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,103.29 / $18,060.00 / $41,418.80
| Facility | | $11,103.29 | $18,060.00 | $41,418.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,104.34 / $17,790.30 / $25,202.13
| Facility | | $13,104.34 | $17,790.30 | $25,202.13 |