- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,486.40 / $22,928.00 / $30,801.60
| Facility | | $10,486.40 | $22,928.00 | $30,801.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,920.00 / $9,853.31 / $18,490.09
| Facility | | $2,920.00 | $9,853.31 | $18,490.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,250.54 / $9,151.06 / $15,027.96
| Facility | | $6,250.54 | $9,151.06 | $15,027.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,161.33 / $16,134.22 / $22,278.47
| Facility | | $9,161.33 | $16,134.22 | $22,278.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,765.55 / $31,765.55 / $37,279.57
| Facility | | $31,765.55 | $31,765.55 | $37,279.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.00 / $14,264.33 / $21,672.55
| Facility | | $2,520.00 | $14,264.33 | $21,672.55 |