- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,360.00 / $17,053.00 / $27,421.30
| Facility | | $8,360.00 | $17,053.00 | $27,421.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,699.83 / $27,749.26 / $37,386.14
| Facility | | $18,699.83 | $27,749.26 | $37,386.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,647.00 / $22,005.94 / $35,185.19
| Facility | | $14,647.00 | $22,005.94 | $35,185.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,337.50 / $23,706.80 / $49,713.92
| Facility | | $12,337.50 | $23,706.80 | $49,713.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,404.36 / $23,550.25 / $35,193.87
| Facility | | $17,404.36 | $23,550.25 | $35,193.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $16,763.00 / $30,268.91
| Facility | | $4,870.00 | $16,763.00 | $30,268.91 |