- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,488.80 / $21,883.80 / $26,424.10
| Facility | | $11,488.80 | $21,883.80 | $26,424.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.00 / $19,760.65 / $33,848.50
| Facility | | $6,916.00 | $19,760.65 | $33,848.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,485.98 / $18,640.32 / $22,227.78
| Facility | | $16,485.98 | $18,640.32 | $22,227.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,283.00 / $15,820.20 / $20,473.20
| Facility | | $11,283.00 | $15,820.20 | $20,473.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,624.63 / $20,049.15 / $30,027.64
| Facility | | $11,624.63 | $20,049.15 | $30,027.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,836.07 / $17,657.41 / $22,750.97
| Facility | | $12,836.07 | $17,657.41 | $22,750.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $18,018.04 / $25,955.38
| Facility | | $3,775.00 | $18,018.04 | $25,955.38 |