- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $21,037.60 / $31,765.20
| Facility | | $4,804.00 | $21,037.60 | $31,765.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,222.75 / $18,222.75 / $25,380.58
| Facility | | $18,222.75 | $18,222.75 | $25,380.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,030.00 / $22,204.58
| Facility | | $688.00 | $3,030.00 | $22,204.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,030.70 / $19,757.00 / $36,935.62
| Facility | | $12,030.70 | $19,757.00 | $36,935.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,526.60 / $46,693.54 / $46,693.54
| Facility | | $28,526.60 | $46,693.54 | $46,693.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,325.00 / $17,515.00 / $40,398.00
| Facility | | $12,325.00 | $17,515.00 | $40,398.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,779.95 / $15,100.73 / $35,461.57
| Facility | | $5,779.95 | $15,100.73 | $35,461.57 |