- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $20,417.38 / $38,904.51
| Facility | | $11,481.54 | $20,417.38 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $21,877.62 / $37,153.52
| Facility | | $10,232.93 | $21,877.62 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $13,803.84 / $31,622.78
| Facility | | $100.00 | $13,803.84 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $18,197.01 / $31,622.78
| Facility | | $12,022.64 | $18,197.01 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,286.14 / $51,286.14 / $51,286.14
| Facility | | $51,286.14 | $51,286.14 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $19,952.62 / $35,481.34
| Facility | | $12,302.69 | $19,952.62 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $17,378.01 / $35,481.34
| Facility | | $5,754.40 | $17,378.01 | $35,481.34 |