- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $26,302.68
| Facility | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $91.20 / $100.00
| Facility | | $72.44 | $91.20 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $40,738.03
| Facility | | $25,118.86 | $25,118.86 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $213.80 / $19,498.45
| Facility | | $134.90 | $213.80 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $40,738.03
| Facility | | $25,118.86 | $25,118.86 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $23,442.29 / $63,095.73
| Facility | | $5,370.32 | $23,442.29 | $63,095.73 |