- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,482.20 / $16,570.20 / $26,869.50
| Facility | | $10,482.20 | $16,570.20 | $26,869.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,722.09 / $8,722.09 / $8,722.09
| Facility | | $8,722.09 | $8,722.09 | $8,722.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,075.75 / $14,766.42 / $33,992.24
| Facility | | $12,075.75 | $14,766.42 | $33,992.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,684.00 / $12,192.72 / $24,279.92
| Facility | | $1,684.00 | $12,192.72 | $24,279.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,283.32 / $17,392.00 / $30,509.05
| Facility | | $11,283.32 | $17,392.00 | $30,509.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,147.60 / $23,447.20 / $27,517.28
| Facility | | $16,147.60 | $23,447.20 | $27,517.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,689.28 / $14,711.89 / $30,775.14
| Facility | | $10,689.28 | $14,711.89 | $30,775.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,693.00 / $13,465.76 / $27,568.06
| Facility | | $5,693.00 | $13,465.76 | $27,568.06 |