- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,744.00 / $23,209.80 / $30,576.80
| Facility | | $16,744.00 | $23,209.80 | $30,576.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,186.38 / $26,218.00 / $38,887.00
| Facility | | $17,186.38 | $26,218.00 | $38,887.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,589.31 / $24,630.66 / $34,480.00
| Facility | | $15,589.31 | $24,630.66 | $34,480.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,233.00 / $24,743.00 / $30,301.78
| Facility | | $16,233.00 | $24,743.00 | $30,301.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,120.00 / $26,715.00 / $45,061.94
| Facility | | $4,120.00 | $26,715.00 | $45,061.94 |