- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,896.20 / $21,784.00 / $40,994.00
| Facility | | $10,896.20 | $21,784.00 | $40,994.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,724.99 / $21,371.83 / $35,727.39
| Facility | | $11,724.99 | $21,371.83 | $35,727.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $12,077.77 / $27,364.00
| Facility | | $100.00 | $12,077.77 | $27,364.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,304.57 / $20,471.41 / $35,546.78
| Facility | | $12,304.57 | $20,471.41 | $35,546.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,718.01 / $26,718.01 / $26,718.01
| Facility | | $26,718.01 | $26,718.01 | $26,718.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,436.94 / $15,373.03 / $36,537.00
| Facility | | $10,436.94 | $15,373.03 | $36,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,693.00 / $13,053.86 / $26,724.79
| Facility | | $5,693.00 | $13,053.86 | $26,724.79 |