- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $22,709.90 / $35,505.80
| Facility | | $4,804.00 | $22,709.90 | $35,505.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,041.11 / $21,041.11 / $33,424.30
| Facility | | $21,041.11 | $21,041.11 | $33,424.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,030.00 / $24,187.86
| Facility | | $688.00 | $3,030.00 | $24,187.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,030.78 / $21,818.73 / $41,285.03
| Facility | | $13,030.78 | $21,818.73 | $41,285.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,023.80 / $49,144.22 / $49,144.22
| Facility | | $30,023.80 | $49,144.22 | $49,144.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,776.00 / $19,577.50 / $45,155.11
| Facility | | $13,776.00 | $19,577.50 | $45,155.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,064.36 / $20,266.63 / $40,904.44
| Facility | | $8,064.36 | $20,266.63 | $40,904.44 |