- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $20,417.38 / $37,153.52
| Facility | | $11,748.98 | $20,417.38 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $16,982.44
| Facility | | $15,848.93 | $15,848.93 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $22,908.68 / $31,622.78
| Facility | | $17,378.01 | $22,908.68 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $19,054.61 / $30,902.95
| Facility | | $100.00 | $19,054.61 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $18,197.01 / $30,902.95
| Facility | | $12,022.64 | $18,197.01 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $31,622.78
| Facility | | $31,622.78 | $31,622.78 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $21,379.62 / $34,673.69
| Facility | | $12,302.69 | $21,379.62 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $17,782.79 / $33,884.42
| Facility | | $5,754.40 | $17,782.79 | $33,884.42 |