- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,316.80 / $22,329.50 / $30,492.90
| Facility | | $12,316.80 | $22,329.50 | $30,492.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,830.80 / $16,973.50 / $22,480.74
| Facility | | $13,830.80 | $16,973.50 | $22,480.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,980.00 / $22,012.30 / $32,045.30
| Facility | | $10,980.00 | $22,012.30 | $32,045.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,247.36 / $20,937.71 / $30,386.32
| Facility | | $11,247.36 | $20,937.71 | $30,386.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,505.65 / $22,505.65 / $27,328.29
| Facility | | $22,505.65 | $22,505.65 | $27,328.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,423.78 / $22,639.52 / $35,354.69
| Facility | | $16,423.78 | $22,639.52 | $35,354.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,294.90 / $21,447.20 / $30,176.00
| Facility | | $12,294.90 | $21,447.20 | $30,176.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,127.98 / $18,465.62 / $28,475.56
| Facility | | $11,127.98 | $18,465.62 | $28,475.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $10,453.99 / $14,644.44
| Facility | | $2,621.40 | $10,453.99 | $14,644.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,352.34 / $17,079.33 / $31,227.65
| Facility | | $6,352.34 | $17,079.33 | $31,227.65 |