- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,982.50 / $19,014.70 / $22,959.80
| Facility | | $9,982.50 | $19,014.70 | $22,959.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.00 / $17,169.90 / $29,472.33
| Facility | | $6,916.00 | $17,169.90 | $29,472.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,907.80 / $16,377.25 / $19,962.96
| Facility | | $12,907.80 | $16,377.25 | $19,962.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,581.41 / $13,035.60 / $17,730.64
| Facility | | $8,581.41 | $13,035.60 | $17,730.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,150.76 / $17,044.80 / $26,164.24
| Facility | | $10,150.76 | $17,044.80 | $26,164.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,184.56 / $15,501.76 / $19,660.04
| Facility | | $11,184.56 | $15,501.76 | $19,660.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $15,655.75 / $22,552.46
| Facility | | $3,775.00 | $15,655.75 | $22,552.46 |