- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,740.00 / $12,947.00 / $27,956.00
| Facility | | $3,740.00 | $12,947.00 | $27,956.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,264.16 / $43,264.16 / $43,264.16
| Facility | | $43,264.16 | $43,264.16 | $43,264.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,220.14 / $34,038.33 / $42,546.26
| Facility | | $24,220.14 | $34,038.33 | $42,546.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,251.00 / $19,714.00 / $27,160.00
| Facility | | $10,251.00 | $19,714.00 | $27,160.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,731.78 / $27,956.00 / $31,785.09
| Facility | | $18,731.78 | $27,956.00 | $31,785.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,614.00 / $25,324.00 / $65,045.26
| Facility | | $10,614.00 | $25,324.00 | $65,045.26 |