- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,913.51 / $17,514.00 / $29,539.20
| Facility | | $11,913.51 | $17,514.00 | $29,539.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,779.54 / $17,779.54 / $17,779.54
| Facility | | $17,779.54 | $17,779.54 | $17,779.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,251.88 / $13,879.85 / $20,019.87
| Facility | | $7,251.88 | $13,879.85 | $20,019.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,987.39 / $15,102.00 / $25,791.16
| Facility | | $10,987.39 | $15,102.00 | $25,791.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,788.73 / $16,670.39 / $22,338.82
| Facility | | $10,788.73 | $16,670.39 | $22,338.82 |