- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,975.30 / $18,390.00 / $28,064.40
| Facility | | $7,975.30 | $18,390.00 | $28,064.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,661.72 / $29,176.64 / $37,833.12
| Facility | | $19,661.72 | $29,176.64 | $37,833.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,648.00 / $22,849.43 / $36,533.83
| Facility | | $14,648.00 | $22,849.43 | $36,533.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,810.40 / $24,615.49 / $51,619.45
| Facility | | $12,810.40 | $24,615.49 | $51,619.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,752.41 / $9,752.41 / $9,752.41
| Facility | | $9,752.41 | $9,752.41 | $9,752.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,646.00 / $24,452.93 / $36,542.86
| Facility | | $17,646.00 | $24,452.93 | $36,542.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,043.57 / $17,110.25 / $31,429.12
| Facility | | $5,043.57 | $17,110.25 | $31,429.12 |