- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,748.80 / $20,474.20 / $24,722.10
| Facility | | $10,748.80 | $20,474.20 | $24,722.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,397.00 / $18,487.84 / $29,981.88
| Facility | | $12,397.00 | $18,487.84 | $29,981.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,490.20 / $17,461.96 / $20,970.66
| Facility | | $15,490.20 | $17,461.96 | $20,970.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,941.10 / $16,248.91 / $59,999.40
| Facility | | $10,941.10 | $16,248.91 | $59,999.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,397.00 / $18,658.50 / $28,787.40
| Facility | | $12,397.00 | $18,658.50 | $28,787.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,369.76 / $16,444.13 / $22,005.48
| Facility | | $11,369.76 | $16,444.13 | $22,005.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $18,063.91 / $25,990.48
| Facility | | $3,775.00 | $18,063.91 | $25,990.48 |