- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,673.80 / $16,873.20 / $27,360.80
| Facility | | $10,673.80 | $16,873.20 | $27,360.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,507.02 / $15,293.79 / $35,206.25
| Facility | | $12,507.02 | $15,293.79 | $35,206.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $12,151.38 / $25,045.11
| Facility | | $100.00 | $12,151.38 | $25,045.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,875.95 / $17,820.82 / $31,066.88
| Facility | | $11,875.95 | $17,820.82 | $31,066.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,724.30 / $24,284.60 / $28,500.04
| Facility | | $16,724.30 | $24,284.60 | $28,500.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,052.10 / $14,980.89 / $31,337.85
| Facility | | $11,052.10 | $14,980.89 | $31,337.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,693.00 / $13,711.97 / $28,072.12
| Facility | | $5,693.00 | $13,711.97 | $28,072.12 |