- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,473.80 / $23,760.00 / $28,689.60
| Facility | | $12,473.80 | $23,760.00 | $28,689.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.00 / $21,454.85 / $36,716.33
| Facility | | $6,916.00 | $21,454.85 | $36,716.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,797.00 / $20,084.59 / $24,315.28
| Facility | | $17,797.00 | $20,084.59 | $24,315.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,538.50 / $17,193.80 / $22,250.80
| Facility | | $11,538.50 | $17,193.80 | $22,250.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,595.19 / $21,425.67 / $32,591.16
| Facility | | $12,595.19 | $21,425.67 | $32,591.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,923.61 / $19,298.07 / $24,913.13
| Facility | | $13,923.61 | $19,298.07 | $24,913.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,903.00 / $22,177.33 / $27,043.09
| Facility | | $12,903.00 | $22,177.33 | $27,043.09 |