- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $21,162.00 / $33,617.30
| Facility | | $4,804.00 | $21,162.00 | $33,617.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,565.15 / $26,565.15 / $26,565.15
| Facility | | $26,565.15 | $26,565.15 | $26,565.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $3,027.00 / $21,366.55
| Facility | | $688.00 | $3,027.00 | $21,366.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,604.65 / $20,019.15 / $35,853.56
| Facility | | $12,604.65 | $20,019.15 | $35,853.56 |
- 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
- $13,044.00 / $18,328.64 / $35,853.56
| Facility | | $13,044.00 | $18,328.64 | $35,853.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,116.96 / $15,981.21 / $37,529.23
| Facility | | $6,116.96 | $15,981.21 | $37,529.23 |