- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,920.20 / $25,236.30 / $34,462.40
| Facility | | $13,920.20 | $25,236.30 | $34,462.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,235.00 / $26,410.54 / $38,114.19
| Facility | | $13,235.00 | $26,410.54 | $38,114.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,509.59 / $23,368.56 / $33,256.00
| Facility | | $13,509.59 | $23,368.56 | $33,256.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,435.44 / $25,435.44 / $30,885.89
| Facility | | $25,435.44 | $25,435.44 | $30,885.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,394.98 / $27,142.47 / $118,790.94
| Facility | | $19,394.98 | $27,142.47 | $118,790.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,895.50 / $24,833.00 / $34,462.40
| Facility | | $13,895.50 | $24,833.00 | $34,462.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,711.55 / $20,869.47 / $33,078.74
| Facility | | $12,711.55 | $20,869.47 | $33,078.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $12,323.98 / $17,440.84
| Facility | | $2,621.40 | $12,323.98 | $17,440.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,179.28 / $19,457.08 / $35,292.87
| Facility | | $7,179.28 | $19,457.08 | $35,292.87 |