- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,734.10 / $20,959.40 / $28,621.90
| Facility | | $11,734.10 | $20,959.40 | $28,621.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,564.00 / $23,479.98 / $31,642.65
| Facility | | $10,564.00 | $23,479.98 | $31,642.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,103.40 / $18,791.56 / $28,521.94
| Facility | | $11,103.40 | $18,791.56 | $28,521.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,124.80 / $21,124.80 / $25,651.54
| Facility | | $21,124.80 | $21,124.80 | $25,651.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,511.80 / $20,511.80 / $23,672.75
| Facility | | $20,511.80 | $20,511.80 | $23,672.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,561.10 / $20,959.40 / $28,621.90
| Facility | | $11,561.10 | $20,959.40 | $28,621.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,445.20 / $17,307.00 / $28,034.29
| Facility | | $10,445.20 | $17,307.00 | $28,034.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $10,551.58 / $14,781.15
| Facility | | $2,621.40 | $10,551.58 | $14,781.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,962.58 / $16,159.61 / $29,311.65
| Facility | | $5,962.58 | $16,159.61 | $29,311.65 |