- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,220.00 / $15,167.50 / $26,648.60
| Facility | | $4,220.00 | $15,167.50 | $26,648.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,753.30 / $16,480.40 / $21,255.52
| Facility | | $14,753.30 | $16,480.40 | $21,255.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,030.00 / $16,833.98
| Facility | | $688.00 | $3,030.00 | $16,833.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,991.75 / $16,375.89 / $30,986.18
| Facility | | $9,991.75 | $16,375.89 | $30,986.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,625.80 / $35,398.01 / $35,398.01
| Facility | | $21,625.80 | $35,398.01 | $35,398.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,072.02 / $20,607.89 / $24,960.92
| Facility | | $10,072.02 | $20,607.89 | $24,960.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,379.67 / $14,693.75 / $33,890.83
| Facility | | $10,379.67 | $14,693.75 | $33,890.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,642.40 / $14,331.00 / $27,423.00
| Facility | | $5,642.40 | $14,331.00 | $27,423.00 |