- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,536.70 / $17,032.20 / $25,474.00
| Facility | | $12,536.70 | $17,032.20 | $25,474.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,551.43 / $23,551.43 / $23,551.43
| Facility | | $23,551.43 | $23,551.43 | $23,551.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,201.28 / $15,568.30 / $22,794.44
| Facility | | $10,201.28 | $15,568.30 | $22,794.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,936.67 / $15,098.72 / $27,328.00
| Facility | | $10,936.67 | $15,098.72 | $27,328.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.25 / $160.13 / $255.20
| Facility | | $116.25 | $160.13 | $255.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,429.94 / $16,649.58 / $26,428.91
| Facility | | $11,429.94 | $16,649.58 | $26,428.91 |