- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,208.70 / $23,593.20 / $32,218.70
| Facility | | $13,208.70 | $23,593.20 | $32,218.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,410.00 / $20,769.61 / $31,675.00
| Facility | | $10,410.00 | $20,769.61 | $31,675.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,883.93 / $22,122.72 / $32,106.09
| Facility | | $11,883.93 | $22,122.72 | $32,106.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,779.40 / $23,779.40 / $28,874.99
| Facility | | $23,779.40 | $23,779.40 | $28,874.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,076.24 / $27,207.02 / $34,954.76
| Facility | | $18,076.24 | $27,207.02 | $34,954.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,013.90 / $23,089.60 / $31,883.90
| Facility | | $13,013.90 | $23,089.60 | $31,883.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,022.74 / $19,510.71 / $30,338.34
| Facility | | $11,022.74 | $19,510.71 | $30,338.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $11,386.56 / $15,994.85
| Facility | | $2,621.40 | $11,386.56 | $15,994.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,594.97 / $19,800.00 / $32,995.04
| Facility | | $6,594.97 | $19,800.00 | $32,995.04 |