- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,875.60 / $20,405.00 / $33,877.10
| Facility | | $12,875.60 | $20,405.00 | $33,877.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,976.00 / $13,972.00 / $16,757.33
| Facility | | $5,976.00 | $13,972.00 | $16,757.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,749.77 / $17,601.84 / $29,817.91
| Facility | | $11,749.77 | $17,601.84 | $29,817.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,731.25 / $21,764.29 / $31,163.81
| Facility | | $16,731.25 | $21,764.29 | $31,163.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,515.64 / $21,850.01 / $52,540.34
| Facility | | $10,515.64 | $21,850.01 | $52,540.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,515.64 / $20,861.59 / $29,319.94
| Facility | | $10,515.64 | $20,861.59 | $29,319.94 |