- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,116.32 / $13,701.70 / $24,111.00
| Facility | | $8,116.32 | $13,701.70 | $24,111.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,628.00 / $3,527.00 / $13,539.65
| Facility | | $2,628.00 | $3,527.00 | $13,539.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,370.97 / $6,414.66 / $10,580.86
| Facility | | $4,370.97 | $6,414.66 | $10,580.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,383.06 / $12,629.61 / $17,573.86
| Facility | | $7,383.06 | $12,629.61 | $17,573.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,617.55 / $25,617.55 / $30,064.37
| Facility | | $25,617.55 | $25,617.55 | $30,064.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.00 / $12,212.00 / $19,972.73
| Facility | | $3,158.00 | $12,212.00 | $19,972.73 |