- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,540.00 / $19,873.09 / $32,994.10
| Facility | | $12,540.00 | $19,873.09 | $32,994.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,815.20 / $6,815.20 / $17,045.75
| Facility | | $6,815.20 | $6,815.20 | $17,045.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,148.16 / $16,700.61 / $28,291.18
| Facility | | $11,148.16 | $16,700.61 | $28,291.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,130.00 / $21,196.98 / $30,478.66
| Facility | | $17,130.00 | $21,196.98 | $30,478.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,241.54 / $20,362.11 / $49,850.19
| Facility | | $10,241.54 | $20,362.11 | $49,850.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,241.54 / $20,317.82 / $28,555.69
| Facility | | $10,241.54 | $20,317.82 | $28,555.69 |