- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $22,387.21 / $31,622.78
| Facility | | $12,882.50 | $22,387.21 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $25,118.86 / $37,153.52
| Facility | | $14,454.40 | $25,118.86 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $20,892.96 / $29,512.09
| Facility | | $12,302.69 | $20,892.96 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $28,840.32
| Facility | | $23,988.33 | $23,988.33 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $22,908.68 / $28,840.32
| Facility | | $9,772.37 | $22,908.68 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $20,892.96 / $42,657.95
| Facility | | $15,848.93 | $20,892.96 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $22,387.21 / $30,902.95
| Facility | | $12,302.69 | $22,387.21 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $12,302.69 / $19,952.62
| Facility | | $10,000.00 | $12,302.69 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $16,218.10 / $28,840.32
| Facility | | $5,370.32 | $16,218.10 | $28,840.32 |