- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,985.00 / $22,829.00 / $27,565.50
| Facility | | $11,985.00 | $22,829.00 | $27,565.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,397.00 / $20,614.20 / $33,220.58
| Facility | | $12,397.00 | $20,614.20 | $33,220.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,233.67 / $19,201.40 / $23,388.32
| Facility | | $15,233.67 | $19,201.40 | $23,388.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,155.59 / $15,085.80 / $59,999.40
| Facility | | $8,155.59 | $15,085.80 | $59,999.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,397.00 / $19,677.23 / $29,070.00
| Facility | | $12,397.00 | $19,677.23 | $29,070.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,597.95 / $16,535.70 / $19,052.98
| Facility | | $12,597.95 | $16,535.70 | $19,052.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $21,495.34 / $28,326.00
| Facility | | $7,500.00 | $21,495.34 | $28,326.00 |