- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,265.20 / $16,227.20 / $26,313.40
| Facility | | $10,265.20 | $16,227.20 | $26,313.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,420.64 / $13,965.35 / $32,148.18
| Facility | | $11,420.64 | $13,965.35 | $32,148.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $11,581.26 / $24,898.04
| Facility | | $100.00 | $11,581.26 | $24,898.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,891.40 / $17,364.98 / $29,877.53
| Facility | | $11,891.40 | $17,364.98 | $29,877.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,271.60 / $22,175.20 / $26,024.48
| Facility | | $15,271.60 | $22,175.20 | $26,024.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,138.21 / $14,646.70 / $30,138.12
| Facility | | $10,138.21 | $14,646.70 | $30,138.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,693.00 / $13,187.03 / $26,997.42
| Facility | | $5,693.00 | $13,187.03 | $26,997.42 |