- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,972.50 / $22,805.20 / $27,536.80
| Facility | | $11,972.50 | $22,805.20 | $27,536.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,397.00 / $20,592.70 / $32,074.92
| Facility | | $12,397.00 | $20,592.70 | $32,074.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,596.50 / $19,181.36 / $23,117.16
| Facility | | $16,596.50 | $19,181.36 | $23,117.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,263.37 / $15,482.80 / $59,999.40
| Facility | | $8,263.37 | $15,482.80 | $59,999.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,397.00 / $19,342.56 / $29,454.20
| Facility | | $12,397.00 | $19,342.56 | $29,454.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,163.49 / $16,589.65 / $22,589.98
| Facility | | $12,163.49 | $16,589.65 | $22,589.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $20,695.18 / $28,949.51
| Facility | | $5,700.00 | $20,695.18 | $28,949.51 |