- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,285.70 / $16,259.60 / $26,365.90
| Facility | | $10,285.70 | $16,259.60 | $26,365.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,716.40 / $13,104.20 / $30,165.81
| Facility | | $10,716.40 | $13,104.20 | $30,165.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $11,973.54 / $23,206.53
| Facility | | $100.00 | $11,973.54 | $23,206.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,056.20 / $17,399.64 / $29,937.18
| Facility | | $12,056.20 | $17,399.64 | $29,937.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,329.90 / $20,807.80 / $24,419.72
| Facility | | $14,329.90 | $20,807.80 | $24,419.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,545.81 / $14,803.05 / $30,198.29
| Facility | | $9,545.81 | $14,803.05 | $30,198.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,693.00 / $11,914.00 / $26,052.10
| Facility | | $5,693.00 | $11,914.00 | $26,052.10 |