- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,576.80 / $21,206.00 / $30,025.40
| Facility | | $11,576.80 | $21,206.00 | $30,025.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,891.03 / $21,891.03 / $21,891.03
| Facility | | $21,891.03 | $21,891.03 | $21,891.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,951.69 / $20,997.24 / $33,234.18
| Facility | | $12,951.69 | $20,997.24 | $33,234.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,036.42 / $19,075.90 / $33,939.06
| Facility | | $12,036.42 | $19,075.90 | $33,939.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $18,018.28 / $40,133.00
| Facility | | $7,117.00 | $18,018.28 | $40,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $17,606.00 / $35,664.28
| Facility | | $3,308.00 | $17,606.00 | $35,664.28 |