- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,531.20 / $17,584.70 / $24,675.00
| Facility | | $12,531.20 | $17,584.70 | $24,675.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,925.56 / $18,524.38 / $23,796.12
| Facility | | $13,925.56 | $18,524.38 | $23,796.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,087.70 / $15,568.30 / $22,794.44
| Facility | | $10,087.70 | $15,568.30 | $22,794.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,871.77 / $15,023.80 / $27,111.13
| Facility | | $10,871.77 | $15,023.80 | $27,111.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.20 / $160.06 / $255.09
| Facility | | $116.20 | $160.06 | $255.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,424.92 / $16,642.27 / $26,417.30
| Facility | | $11,424.92 | $16,642.27 | $26,417.30 |