- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,072.60 / $15,072.60 / $17,864.00
| Facility | | $15,072.60 | $15,072.60 | $17,864.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,070.26 / $18,011.90 / $26,944.71
| Facility | | $11,070.26 | $18,011.90 | $26,944.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,327.52 / $15,257.91 / $25,959.57
| Facility | | $12,327.52 | $15,257.91 | $25,959.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,029.22 / $17,696.41 / $28,966.47
| Facility | | $11,029.22 | $17,696.41 | $28,966.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.85 / $10,277.86 / $14,780.92
| Facility | | $162.85 | $10,277.86 | $14,780.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,550.71 / $17,483.30 / $20,547.25
| Facility | | $12,550.71 | $17,483.30 | $20,547.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,327.01 / $18,648.49 / $23,507.94
| Facility | | $11,327.01 | $18,648.49 | $23,507.94 |