- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $20,854.00 / $32,091.70
| Facility | | $4,804.00 | $20,854.00 | $32,091.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,889.75 / $11,840.36 / $21,636.46
| Facility | | $9,889.75 | $11,840.36 | $21,636.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.00 / $1,175.00 / $2,500.00
| Facility | | $561.00 | $1,175.00 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,740.40 / $30,108.40 / $42,554.35
| Facility | | $12,740.40 | $30,108.40 | $42,554.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,510.10 / $45,029.69 / $45,029.69
| Facility | | $27,510.10 | $45,029.69 | $45,029.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,324.80 / $16,075.20 / $42,554.35
| Facility | | $11,324.80 | $16,075.20 | $42,554.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,432.00 / $15,854.72 / $36,100.62
| Facility | | $4,432.00 | $15,854.72 | $36,100.62 |