- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,592.91 / $11,776.20 / $16,081.40
| Facility | | $6,592.91 | $11,776.20 | $16,081.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,351.00 / $12,212.48 / $19,587.22
| Facility | | $8,351.00 | $12,212.48 | $19,587.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,238.52 / $11,042.20 / $16,203.15
| Facility | | $6,238.52 | $11,042.20 | $16,203.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,869.10 / $11,869.10 / $14,412.48
| Facility | | $11,869.10 | $11,869.10 | $14,412.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,197.21 / $14,197.21 / $16,385.56
| Facility | | $14,197.21 | $14,197.21 | $16,385.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,495.67 / $11,524.80 / $16,081.40
| Facility | | $6,495.67 | $11,524.80 | $16,081.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,868.71 / $9,738.45 / $15,183.92
| Facility | | $5,868.71 | $9,738.45 | $15,183.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $5,531.78 / $7,463.37
| Facility | | $2,621.40 | $5,531.78 | $7,463.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,033.68 / $9,079.37 / $16,468.93
| Facility | | $4,033.68 | $9,079.37 | $16,468.93 |