- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,763.00 / $20,763.00 / $24,608.20
| Facility | | $20,763.00 | $20,763.00 | $24,608.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,775.98 / $22,414.26 / $33,530.37
| Facility | | $13,775.98 | $22,414.26 | $33,530.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,981.55 / $21,018.26 / $35,760.12
| Facility | | $16,981.55 | $21,018.26 | $35,760.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,193.10 / $24,377.36 / $39,902.23
| Facility | | $15,193.10 | $24,377.36 | $39,902.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.65 / $12,789.91 / $20,265.13
| Facility | | $202.65 | $12,789.91 | $20,265.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,289.00 / $24,083.80 / $28,304.50
| Facility | | $17,289.00 | $24,083.80 | $28,304.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,603.32 / $25,688.89 / $32,382.94
| Facility | | $15,603.32 | $25,688.89 | $32,382.94 |