- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,071.70 / $16,168.00 / $21,250.30
| Facility | | $11,071.70 | $16,168.00 | $21,250.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,046.20 / $12,046.20 / $12,046.20
| Facility | | $12,046.20 | $12,046.20 | $12,046.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,727.10 / $15,597.05 / $26,380.32
| Facility | | $5,727.10 | $15,597.05 | $26,380.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,247.33 / $16,239.82 / $27,181.80
| Facility | | $11,247.33 | $16,239.82 | $27,181.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,926.69 / $18,123.86 / $26,462.31
| Facility | | $13,926.69 | $18,123.86 | $26,462.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,521.75 / $17,440.30 / $25,139.10
| Facility | | $11,521.75 | $17,440.30 | $25,139.10 |