- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,994.50 / $17,994.50 / $21,327.00
| Facility | | $17,994.50 | $17,994.50 | $21,327.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,676.48 / $20,625.30 / $30,854.20
| Facility | | $12,676.48 | $20,625.30 | $30,854.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,717.26 / $18,215.72 / $30,991.94
| Facility | | $14,717.26 | $18,215.72 | $30,991.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,167.28 / $21,126.93 / $34,581.74
| Facility | | $13,167.28 | $21,126.93 | $34,581.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.48 / $11,769.11 / $17,646.25
| Facility | | $186.48 | $11,769.11 | $17,646.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,983.72 / $20,872.50 / $24,530.43
| Facility | | $14,983.72 | $20,872.50 | $24,530.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,522.80 / $22,263.58 / $28,065.06
| Facility | | $13,522.80 | $22,263.58 | $28,065.06 |