- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,147.00 / $18,716.00 / $32,131.20
| Facility | | $9,147.00 | $18,716.00 | $32,131.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,825.50 / $32,387.54 / $41,996.67
| Facility | | $21,825.50 | $32,387.54 | $41,996.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,648.00 / $25,785.69 / $41,228.60
| Facility | | $14,648.00 | $25,785.69 | $41,228.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,456.59 / $27,778.68 / $58,252.78
| Facility | | $14,456.59 | $27,778.68 | $58,252.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,891.75 / $11,891.75 / $11,891.75
| Facility | | $11,891.75 | $11,891.75 | $11,891.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,646.00 / $27,595.24 / $41,238.76
| Facility | | $17,646.00 | $27,595.24 | $41,238.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,281.00 / $18,974.20 / $35,467.90
| Facility | | $5,281.00 | $18,974.20 | $35,467.90 |