- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,990.00 / $20,990.00 / $24,877.30
| Facility | | $20,990.00 | $20,990.00 | $24,877.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,151.18 / $24,651.79 / $36,877.57
| Facility | | $15,151.18 | $24,651.79 | $36,877.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,167.27 / $21,248.12 / $36,151.22
| Facility | | $17,167.27 | $21,248.12 | $36,151.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,359.26 / $24,643.97 / $40,338.62
| Facility | | $15,359.26 | $24,643.97 | $40,338.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.88 / $14,066.68 / $20,583.86
| Facility | | $222.88 | $14,066.68 | $20,583.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,478.08 / $24,347.19 / $28,614.05
| Facility | | $17,478.08 | $24,347.19 | $28,614.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,773.96 / $25,969.84 / $32,737.09
| Facility | | $15,773.96 | $25,969.84 | $32,737.09 |