- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,288.42 / $12,777.60 / $22,450.10
| Facility | | $6,288.42 | $12,777.60 | $22,450.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,055.00 / $20,799.02 / $26,969.93
| Facility | | $14,055.00 | $20,799.02 | $26,969.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,249.11 / $18,016.47 / $28,806.44
| Facility | | $14,249.11 | $18,016.47 | $28,806.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,100.82 / $19,408.98 / $40,701.24
| Facility | | $10,100.82 | $19,408.98 | $40,701.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,249.11 / $19,280.81 / $28,813.55
| Facility | | $14,249.11 | $19,280.81 | $28,813.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $15,806.00 / $24,781.44
| Facility | | $4,870.00 | $15,806.00 | $24,781.44 |