- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,976.90 / $19,018.80 / $25,971.80
| Facility | | $10,976.90 | $19,018.80 | $25,971.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,918.00 / $18,246.18 / $29,712.00
| Facility | | $8,918.00 | $18,246.18 | $29,712.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,579.78 / $17,051.65 / $25,881.10
| Facility | | $9,579.78 | $17,051.65 | $25,881.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,168.86 / $19,168.86 / $23,276.47
| Facility | | $19,168.86 | $19,168.86 | $23,276.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,042.31 / $23,320.53 / $29,109.98
| Facility | | $10,042.31 | $23,320.53 | $29,109.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,490.60 / $18,612.80 / $25,702.00
| Facility | | $10,490.60 | $18,612.80 | $25,702.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,478.09 / $15,704.55 / $24,520.26
| Facility | | $9,478.09 | $15,704.55 | $24,520.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $9,288.17 / $12,927.25
| Facility | | $2,621.40 | $9,288.17 | $12,927.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.51 / $14,547.07 / $26,597.69
| Facility | | $5,410.51 | $14,547.07 | $26,597.69 |