- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,636.70 / $15,536.70 / $23,970.00
| Facility | | $11,636.70 | $15,536.70 | $23,970.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,570.73 / $19,570.73 / $28,287.52
| Facility | | $19,570.73 | $19,570.73 | $28,287.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,469.42 / $14,597.38 / $21,193.48
| Facility | | $9,469.42 | $14,597.38 | $21,193.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,151.46 / $14,014.72 / $25,366.00
| Facility | | $10,151.46 | $14,014.72 | $25,366.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.90 / $148.63 / $236.88
| Facility | | $107.90 | $148.63 | $236.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,181.33 / $15,474.53 / $25,467.46
| Facility | | $11,181.33 | $15,474.53 | $25,467.46 |