- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,763.80 / $22,407.60 / $27,056.60
| Facility | | $11,763.80 | $22,407.60 | $27,056.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.00 / $20,233.65 / $33,260.98
| Facility | | $6,916.00 | $20,233.65 | $33,260.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,695.20 / $18,846.91 / $22,749.34
| Facility | | $14,695.20 | $18,846.91 | $22,749.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,759.20 / $15,062.00 / $19,995.54
| Facility | | $9,759.20 | $15,062.00 | $19,995.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,425.80 / $19,366.20 / $29,506.44
| Facility | | $11,425.80 | $19,366.20 | $29,506.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,613.27 / $17,493.53 / $22,126.84
| Facility | | $12,613.27 | $17,493.53 | $22,126.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $18,449.32 / $26,576.66
| Facility | | $3,775.00 | $18,449.32 | $26,576.66 |