- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $17,927.00 / $28,824.90
| Facility | | $4,804.00 | $17,927.00 | $28,824.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,175.73 / $10,175.73 / $10,175.73
| Facility | | $10,175.73 | $10,175.73 | $10,175.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.00 / $2,767.00 / $18,558.71
| Facility | | $687.00 | $2,767.00 | $18,558.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,917.10 / $17,928.00 / $30,742.33
| Facility | | $10,917.10 | $17,928.00 | $30,742.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,651.20 / $38,713.28 / $38,713.28
| Facility | | $23,651.20 | $38,713.28 | $38,713.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,227.35 / $15,893.75 / $30,742.33
| Facility | | $11,227.35 | $15,893.75 | $30,742.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,958.85 / $14,240.80 / $32,558.03
| Facility | | $4,958.85 | $14,240.80 | $32,558.03 |