- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.46 / $5,116.62 / $18,800.00
| Facility | | $1,307.46 | $5,116.62 | $18,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,542.00 / $57,131.89 / $109,349.35
| Facility | | $26,542.00 | $57,131.89 | $109,349.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,875.66 / $23,875.66 / $39,776.57
| Facility | | $23,875.66 | $23,875.66 | $39,776.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.79 / $1,619.81 / $42,431.62
| Facility | | $882.79 | $1,619.81 | $42,431.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.00 / $1,374.17 / $1,441.84
| Facility | | $1,047.00 | $1,374.17 | $1,441.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.30 / $983.46 / $15,992.56
| Facility | | $951.30 | $983.46 | $15,992.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,068.65 / $57,131.89 / $109,349.35
| Facility | | $37,068.65 | $57,131.89 | $109,349.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,960.00 / $11,798.00 / $43,830.00
| Facility | | $3,960.00 | $11,798.00 | $43,830.00 |