- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,920.00 / $17,940.90 / $36,460.69
| Facility | | $13,920.00 | $17,940.90 | $36,460.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,164.24 / $17,804.61 / $21,884.45
| Facility | | $12,164.24 | $17,804.61 | $21,884.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,076.46 / $17,645.14 / $20,172.96
| Facility | | $14,076.46 | $17,645.14 | $20,172.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,111.10 / $19,667.81 / $25,578.84
| Facility | | $11,111.10 | $19,667.81 | $25,578.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,370.50 / $20,475.30 / $25,607.92
| Facility | | $14,370.50 | $20,475.30 | $25,607.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $15,773.10 / $24,290.96
| Facility | | $1,286.00 | $15,773.10 | $24,290.96 |