- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,902.40 / $28,038.20 / $37,625.00
| Facility | | $16,902.40 | $28,038.20 | $37,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,107.05 / $19,107.05 / $19,107.05
| Facility | | $19,107.05 | $19,107.05 | $19,107.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,408.19 / $22,835.47 / $36,537.62
| Facility | | $13,408.19 | $22,835.47 | $36,537.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,879.11 / $22,575.00 / $51,773.51
| Facility | | $13,879.11 | $22,575.00 | $51,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,380.42 / $22,237.88 / $31,502.66
| Facility | | $16,380.42 | $22,237.88 | $31,502.66 |