- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,585.20 / $21,250.70 / $36,568.00
| Facility | | $14,585.20 | $21,250.70 | $36,568.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,975.74 / $17,975.74 / $17,975.74
| Facility | | $17,975.74 | $17,975.74 | $17,975.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,904.70 / $19,432.43 / $28,728.00
| Facility | | $12,904.70 | $19,432.43 | $28,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,828.51 / $19,091.09 / $34,554.00
| Facility | | $13,828.51 | $19,091.09 | $34,554.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $197.08 / $322.68
| Facility | | $138.04 | $197.08 | $322.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,452.21 / $21,052.02 / $33,417.17
| Facility | | $14,452.21 | $21,052.02 | $33,417.17 |