- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,356.05 / $12,915.00 / $22,691.50
| Facility | | $6,356.05 | $12,915.00 | $22,691.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,485.13 / $22,978.87 / $29,796.52
| Facility | | $15,485.13 | $22,978.87 | $29,796.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,402.36 / $18,210.24 / $29,116.26
| Facility | | $14,402.36 | $18,210.24 | $29,116.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,209.45 / $19,617.73 / $41,139.00
| Facility | | $10,209.45 | $19,617.73 | $41,139.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,594.15 / $7,594.15 / $7,594.15
| Facility | | $7,594.15 | $7,594.15 | $7,594.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,402.36 / $19,488.18 / $29,123.45
| Facility | | $14,402.36 | $19,488.18 | $29,123.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $15,879.35 / $25,047.97
| Facility | | $4,870.00 | $15,879.35 | $25,047.97 |