- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,764.70 / $18,597.70 / $30,157.20
| Facility | | $11,764.70 | $18,597.70 | $30,157.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,831.64 / $18,831.64 / $18,844.16
| Facility | | $18,831.64 | $18,831.64 | $18,844.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,540.18 / $16,557.15 / $38,114.49
| Facility | | $13,540.18 | $16,557.15 | $38,114.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $15,895.57 / $33,275.03
| Facility | | $100.00 | $15,895.57 | $33,275.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,168.59 / $21,604.82 / $34,540.64
| Facility | | $14,168.59 | $21,604.82 | $34,540.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,105.83 / $26,290.65 / $30,854.31
| Facility | | $18,105.83 | $26,290.65 | $30,854.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,922.31 / $17,191.11 / $35,953.89
| Facility | | $11,922.31 | $17,191.11 | $35,953.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,693.00 / $15,113.36 / $30,941.15
| Facility | | $5,693.00 | $15,113.36 | $30,941.15 |