- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,931.20 / $12,931.20 / $15,326.00
| Facility | | $12,931.20 | $12,931.20 | $15,326.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,897.40 / $14,476.54 / $21,656.02
| Facility | | $8,897.40 | $14,476.54 | $21,656.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,576.11 / $13,090.17 / $22,271.41
| Facility | | $10,576.11 | $13,090.17 | $22,271.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,462.26 / $15,182.22 / $24,851.11
| Facility | | $9,462.26 | $15,182.22 | $24,851.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.88 / $8,260.53 / $12,680.95
| Facility | | $130.88 | $8,260.53 | $12,680.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,767.59 / $14,999.39 / $17,628.04
| Facility | | $10,767.59 | $14,999.39 | $17,628.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,717.75 / $15,999.04 / $20,168.09
| Facility | | $9,717.75 | $15,999.04 | $20,168.09 |