- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,682.30 / $16,886.50 / $27,382.50
| Facility | | $10,682.30 | $16,886.50 | $27,382.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,219.00 / $12,514.07 / $28,596.96
| Facility | | $10,219.00 | $12,514.07 | $28,596.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $11,683.14 / $24,187.80
| Facility | | $100.00 | $11,683.14 | $24,187.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,910.58 / $18,751.82 / $35,420.76
| Facility | | $11,910.58 | $18,751.82 | $35,420.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,299.85 / $25,299.85 / $25,299.85
| Facility | | $25,299.85 | $25,299.85 | $25,299.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,871.85 / $14,977.67 / $32,645.84
| Facility | | $9,871.85 | $14,977.67 | $32,645.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,693.00 / $13,722.81 / $28,094.31
| Facility | | $5,693.00 | $13,722.81 | $28,094.31 |