- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,553.80 / $22,007.60 / $26,573.60
| Facility | | $11,553.80 | $22,007.60 | $26,573.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.00 / $19,872.45 / $32,423.76
| Facility | | $6,916.00 | $19,872.45 | $32,423.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,110.85 / $18,510.48 / $22,351.04
| Facility | | $16,110.85 | $18,510.48 | $22,351.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,772.01 / $15,281.30 / $19,775.80
| Facility | | $10,772.01 | $15,281.30 | $19,775.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,141.22 / $19,205.25 / $28,763.73
| Facility | | $11,141.22 | $19,205.25 | $28,763.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,295.78 / $17,070.31 / $21,740.47
| Facility | | $12,295.78 | $17,070.31 | $21,740.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $18,119.98 / $26,102.23
| Facility | | $3,775.00 | $18,119.98 | $26,102.23 |