- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,077.50 / $21,100.40 / $25,478.30
| Facility | | $11,077.50 | $21,100.40 | $25,478.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,397.00 / $19,053.30 / $29,871.72
| Facility | | $12,397.00 | $19,053.30 | $29,871.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,889.60 / $17,747.50 / $21,228.42
| Facility | | $14,889.60 | $17,747.50 | $21,228.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,915.02 / $14,398.95 / $18,843.00
| Facility | | $9,915.02 | $14,398.95 | $18,843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,833.00 / $17,995.82 / $28,581.51
| Facility | | $12,833.00 | $17,995.82 | $28,581.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,327.99 / $15,906.37 / $21,901.46
| Facility | | $11,327.99 | $15,906.37 | $21,901.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $18,616.40 / $26,785.40
| Facility | | $3,775.00 | $18,616.40 | $26,785.40 |