- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,601.20 / $21,693.60 / $38,202.40
| Facility | | $13,601.20 | $21,693.60 | $38,202.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,083.31 / $18,742.95 / $27,470.80
| Facility | | $9,083.31 | $18,742.95 | $27,470.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,576.49 / $16,867.91 / $28,257.69
| Facility | | $12,576.49 | $16,867.91 | $28,257.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,647.13 / $14,948.10 / $19,100.83
| Facility | | $10,647.13 | $14,948.10 | $19,100.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,600.00 / $16,559.32 / $25,708.83
| Facility | | $6,600.00 | $16,559.32 | $25,708.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,990.44 / $18,196.16 / $24,738.67
| Facility | | $12,990.44 | $18,196.16 | $24,738.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $13,588.04 / $35,397.21
| Facility | | $3,775.00 | $13,588.04 | $35,397.21 |