- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $15,488.17 / $15,848.93
| Facility | | $12,882.50 | $15,488.17 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $16,595.87 / $23,988.33
| Facility | | $9,549.93 | $16,595.87 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $13,489.63 / $23,988.33
| Facility | | $10,000.00 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $12,882.50 / $16,595.87
| Facility | | $11,220.18 | $12,882.50 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $15,135.61 / $25,118.86
| Facility | | $9,549.93 | $15,135.61 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $9,772.37 / $12,882.50
| Facility | | $109.65 | $9,772.37 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $17,782.79 / $18,197.01
| Facility | | $14,125.38 | $17,782.79 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $16,218.10 / $22,387.21
| Facility | | $9,772.37 | $16,218.10 | $22,387.21 |