- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $18,302.00 / $27,646.10
| Facility | | $4,804.00 | $18,302.00 | $27,646.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,768.55 / $18,768.55 / $18,768.55
| Facility | | $18,768.55 | $18,768.55 | $18,768.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.00 / $2,767.00 / $19,421.20
| Facility | | $687.00 | $2,767.00 | $19,421.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,664.53 / $18,292.50 / $33,485.03
| Facility | | $10,664.53 | $18,292.50 | $33,485.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,143.30 / $39,518.76 / $39,518.76
| Facility | | $24,143.30 | $39,518.76 | $39,518.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,727.00 / $15,451.07 / $36,659.39
| Facility | | $10,727.00 | $15,451.07 | $36,659.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,756.05 / $13,658.40 / $31,226.52
| Facility | | $4,756.05 | $13,658.40 | $31,226.52 |