- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,162.10 / $19,937.59 / $27,226.60
| Facility | | $11,162.10 | $19,937.59 | $27,226.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,207.00 / $21,894.00 / $29,796.93
| Facility | | $10,207.00 | $21,894.00 | $29,796.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,562.09 / $17,875.43 / $27,131.44
| Facility | | $10,562.09 | $17,875.43 | $27,131.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,094.91 / $20,094.91 / $24,400.98
| Facility | | $20,094.91 | $20,094.91 | $24,400.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,890.14 / $311,185.00 / $567,430.48
| Facility | | $40,890.14 | $311,185.00 | $567,430.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,997.50 / $19,937.59 / $27,226.60
| Facility | | $10,997.50 | $19,937.59 | $27,226.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,935.99 / $16,463.25 / $26,786.36
| Facility | | $9,935.99 | $16,463.25 | $26,786.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $10,092.53 / $14,123.17
| Facility | | $2,621.40 | $10,092.53 | $14,123.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,671.89 / $15,371.80 / $27,882.65
| Facility | | $5,671.89 | $15,371.80 | $27,882.65 |