- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,305.70 / $16,437.40 / $28,946.20
| Facility | | $10,305.70 | $16,437.40 | $28,946.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,600.00 / $13,478.40 / $19,706.52
| Facility | | $6,600.00 | $13,478.40 | $19,706.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,529.29 / $12,780.94 / $21,411.05
| Facility | | $9,529.29 | $12,780.94 | $21,411.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,057.47 / $11,304.32 / $14,710.50
| Facility | | $8,057.47 | $11,304.32 | $14,710.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,775.09 / $11,920.70 / $18,442.55
| Facility | | $5,775.09 | $11,920.70 | $18,442.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,318.85 / $13,053.24 / $17,746.59
| Facility | | $9,318.85 | $13,053.24 | $17,746.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $10,295.75 / $26,820.72
| Facility | | $3,775.00 | $10,295.75 | $26,820.72 |