- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,975.00 / $19,975.00 / $23,674.30
| Facility | | $19,975.00 | $19,975.00 | $23,674.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,805.40 / $22,462.13 / $33,601.98
| Facility | | $13,805.40 | $22,462.13 | $33,601.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,337.07 / $20,220.58 / $34,402.97
| Facility | | $16,337.07 | $20,220.58 | $34,402.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,616.49 / $23,452.20 / $38,387.87
| Facility | | $14,616.49 | $23,452.20 | $38,387.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.08 / $12,817.23 / $19,588.43
| Facility | | $203.08 | $12,817.23 | $19,588.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,632.84 / $23,169.78 / $27,230.30
| Facility | | $16,632.84 | $23,169.78 | $27,230.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,011.14 / $24,713.95 / $31,153.95
| Facility | | $15,011.14 | $24,713.95 | $31,153.95 |