- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,762.00 / $19,026.20 / $38,666.19
| Facility | | $14,762.00 | $19,026.20 | $38,666.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,648.19 / $22,648.19 / $22,648.19
| Facility | | $22,648.19 | $22,648.19 | $22,648.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,491.81 / $18,165.79 / $20,768.18
| Facility | | $14,491.81 | $18,165.79 | $20,768.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,680.20 / $19,407.25 / $26,677.00
| Facility | | $11,680.20 | $19,407.25 | $26,677.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,045.42 / $26,045.42 / $26,045.42
| Facility | | $26,045.42 | $26,045.42 | $26,045.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $16,727.20 / $25,760.30
| Facility | | $1,286.00 | $16,727.20 | $25,760.30 |