- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,799.40 / $22,823.40 / $34,016.00
| Facility | | $16,799.40 | $22,823.40 | $34,016.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,294.37 / $20,362.55 / $30,357.98
| Facility | | $13,294.37 | $20,362.55 | $30,357.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,655.32 / $20,232.55 / $36,620.00
| Facility | | $14,655.32 | $20,232.55 | $36,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.30 / $208.86 / $341.98
| Facility | | $146.30 | $208.86 | $341.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,142.10 / $22,340.03 / $36,766.48
| Facility | | $16,142.10 | $22,340.03 | $36,766.48 |