- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,282.50 / $21,490.90 / $25,949.80
| Facility | | $11,282.50 | $21,490.90 | $25,949.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.00 / $19,405.90 / $33,310.44
| Facility | | $6,916.00 | $19,405.90 | $33,310.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,295.60 / $18,353.22 / $21,841.12
| Facility | | $14,295.60 | $18,353.22 | $21,841.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,524.33 / $15,102.80 / $20,346.53
| Facility | | $9,524.33 | $15,102.80 | $20,346.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,622.13 / $19,362.68 / $30,024.38
| Facility | | $11,622.13 | $19,362.68 | $30,024.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,834.67 / $17,418.84 / $22,327.45
| Facility | | $12,834.67 | $17,418.84 | $22,327.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $17,694.57 / $25,489.42
| Facility | | $3,775.00 | $17,694.57 | $25,489.42 |