- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,832.00 / $13,832.00 / $16,393.59
| Facility | | $13,832.00 | $13,832.00 | $16,393.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,724.48 / $15,822.25 / $23,669.12
| Facility | | $9,724.48 | $15,822.25 | $23,669.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,312.83 / $14,002.02 / $23,822.82
| Facility | | $11,312.83 | $14,002.02 | $23,822.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,121.40 / $16,239.80 / $26,582.22
| Facility | | $10,121.40 | $16,239.80 | $26,582.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.05 / $9,028.41 / $13,564.29
| Facility | | $143.05 | $9,028.41 | $13,564.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,517.65 / $16,044.24 / $18,856.00
| Facility | | $11,517.65 | $16,044.24 | $18,856.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,394.68 / $17,113.52 / $21,572.99
| Facility | | $10,394.68 | $17,113.52 | $21,572.99 |