- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,429.00 / $15,429.00 / $18,286.40
| Facility | | $15,429.00 | $15,429.00 | $18,286.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,484.34 / $18,685.64 / $27,952.58
| Facility | | $11,484.34 | $18,685.64 | $27,952.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,619.01 / $15,618.70 / $26,573.40
| Facility | | $12,619.01 | $15,618.70 | $26,573.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,290.01 / $18,114.84 / $29,651.40
| Facility | | $11,290.01 | $18,114.84 | $29,651.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.94 / $10,662.31 / $15,233.87
| Facility | | $168.94 | $10,662.31 | $15,233.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,847.48 / $17,896.70 / $21,033.11
| Facility | | $12,847.48 | $17,896.70 | $21,033.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,769.92 / $18,948.16 / $24,063.80
| Facility | | $10,769.92 | $18,948.16 | $24,063.80 |