- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $21,012.10 / $31,726.70
| Facility | | $4,804.00 | $21,012.10 | $31,726.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,030.00 / $21,185.81
| Facility | | $688.00 | $3,030.00 | $21,185.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,016.11 / $19,733.00 / $36,890.82
| Facility | | $12,016.11 | $19,733.00 | $36,890.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,918.60 / $45,698.34 / $45,698.34
| Facility | | $27,918.60 | $45,698.34 | $45,698.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72,846.75 / $72,846.75 / $72,846.75
| Facility | | $72,846.75 | $72,846.75 | $72,846.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,310.00 / $17,493.75 / $40,348.98
| Facility | | $12,310.00 | $17,493.75 | $40,348.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,257.00 / $15,674.40 / $35,835.60
| Facility | | $5,257.00 | $15,674.40 | $35,835.60 |