- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $25,666.40 / $38,754.40
| Facility | | $4,804.00 | $25,666.40 | $38,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,545.14 / $23,545.14 / $23,545.14
| Facility | | $23,545.14 | $23,545.14 | $23,545.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,027.00 / $26,290.00
| Facility | | $688.00 | $3,027.00 | $26,290.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,530.75 / $23,078.25 / $41,332.29
| Facility | | $14,530.75 | $23,078.25 | $41,332.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,072.10 / $57,407.49 / $57,407.49
| Facility | | $35,072.10 | $57,407.49 | $57,407.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,094.89 / $21,129.42 / $41,332.29
| Facility | | $15,094.89 | $21,129.42 | $41,332.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,257.00 / $19,146.40 / $43,773.46
| Facility | | $5,257.00 | $19,146.40 | $43,773.46 |