- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,791.45 / $15,400.00 / $21,444.10
| Facility | | $8,791.45 | $15,400.00 | $21,444.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,833.00 / $12,242.55 / $21,451.00
| Facility | | $7,833.00 | $12,242.55 | $21,451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,318.89 / $14,983.80 / $21,606.45
| Facility | | $8,318.89 | $14,983.80 | $21,606.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,827.12 / $15,827.12 / $19,218.64
| Facility | | $15,827.12 | $15,827.12 | $19,218.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,661.79 / $14,678.40 / $21,221.30
| Facility | | $8,661.79 | $14,678.40 | $21,221.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,825.76 / $14,052.12 / $20,247.34
| Facility | | $7,825.76 | $14,052.12 | $20,247.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $7,685.37 / $10,613.22
| Facility | | $2,621.40 | $7,685.37 | $10,613.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,152.64 / $12,107.10 / $21,960.87
| Facility | | $5,152.64 | $12,107.10 | $21,960.87 |