- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,765.90 / $23,143.60 / $31,604.70
| Facility | | $12,765.90 | $23,143.60 | $31,604.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,534.00 / $22,109.62 / $35,637.50
| Facility | | $8,534.00 | $22,109.62 | $35,637.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,581.61 / $10,581.61 / $22,318.00
| Facility | | $10,581.61 | $10,581.61 | $22,318.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,708.00 / $3,708.00 / $3,708.00
| Facility | | $3,708.00 | $3,708.00 | $3,708.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,201.92 / $14,201.92 / $24,651.72
| Facility | | $14,201.92 | $14,201.92 | $24,651.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,743.20 / $22,229.20 / $31,276.30
| Facility | | $12,743.20 | $22,229.20 | $31,276.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,581.61 / $10,581.61 / $22,318.00
| Facility | | $10,581.61 | $10,581.61 | $22,318.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $11,448.56 / $16,092.66
| Facility | | $2,621.40 | $11,448.56 | $16,092.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,932.78 / $17,843.64 / $32,366.28
| Facility | | $5,932.78 | $17,843.64 | $32,366.28 |