- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,063.20 / $22,633.60 / $31,040.00
| Facility | | $13,063.20 | $22,633.60 | $31,040.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,436.00 / $27,744.43 / $35,854.92
| Facility | | $13,436.00 | $27,744.43 | $35,854.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,116.27 / $21,596.64 / $31,828.69
| Facility | | $12,116.27 | $21,596.64 | $31,828.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,812.14 / $22,812.14 / $27,700.46
| Facility | | $22,812.14 | $22,812.14 | $27,700.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,413.80 / $38,732.29 / $41,029.98
| Facility | | $31,413.80 | $38,732.29 | $41,029.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,484.50 / $22,633.60 / $30,908.10
| Facility | | $12,484.50 | $22,633.60 | $30,908.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,400.53 / $20,253.77 / $31,828.69
| Facility | | $11,400.53 | $20,253.77 | $31,828.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $11,884.65 / $16,780.64
| Facility | | $2,621.40 | $11,884.65 | $16,780.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,438.84 / $17,450.36 / $31,652.92
| Facility | | $6,438.84 | $17,450.36 | $31,652.92 |