- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,391.50 / $20,391.50 / $24,168.00
| Facility | | $20,391.50 | $20,391.50 | $24,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,047.72 / $19,602.28 / $29,323.82
| Facility | | $12,047.72 | $19,602.28 | $29,323.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,677.75 / $20,642.25 / $35,120.40
| Facility | | $16,677.75 | $20,642.25 | $35,120.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,921.30 / $23,941.26 / $39,188.40
| Facility | | $14,921.30 | $23,941.26 | $39,188.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.23 / $11,185.36 / $17,722.77
| Facility | | $177.23 | $11,185.36 | $17,722.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,979.71 / $23,652.95 / $27,798.15
| Facility | | $16,979.71 | $23,652.95 | $27,798.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,324.18 / $25,229.33 / $31,803.62
| Facility | | $15,324.18 | $25,229.33 | $31,803.62 |