- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $14,454.40 / $27,542.29
| Facility | | $8,128.31 | $14,454.40 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $15,488.17 / $26,302.68
| Facility | | $8,912.51 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $10,964.78 / $22,387.21
| Facility | | $100.00 | $10,964.78 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $12,882.50 / $22,908.68
| Facility | | $9,332.54 | $12,882.50 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $22,387.21 / $22,387.21
| Facility | | $22,387.21 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,454.40 / $26,302.68
| Facility | | $8,912.51 | $14,454.40 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $12,302.69 / $25,118.86
| Facility | | $5,623.41 | $12,302.69 | $25,118.86 |