- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $15,848.93 / $16,595.87
| Facility | | $13,182.57 | $15,848.93 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $16,982.44 / $24,547.09
| Facility | | $9,772.37 | $16,982.44 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $13,803.84 / $25,118.86
| Facility | | $10,232.93 | $13,803.84 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $13,182.57 / $16,982.44
| Facility | | $11,748.98 | $13,182.57 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $15,488.17 / $25,703.96
| Facility | | $9,772.37 | $15,488.17 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $10,000.00 / $13,182.57
| Facility | | $112.20 | $10,000.00 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $18,197.01 / $19,054.61
| Facility | | $14,454.40 | $18,197.01 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $16,982.44 / $22,908.68
| Facility | | $10,000.00 | $16,982.44 | $22,908.68 |