- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $13,269.00 / $22,198.50
| Facility | | $4,804.00 | $13,269.00 | $22,198.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,958.03 / $14,843.66
| Facility | | $688.00 | $2,958.03 | $14,843.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,407.41 / $13,807.00 / $25,306.44
| Facility | | $8,407.41 | $13,807.00 | $25,306.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,506.59 / $28,655.54 / $28,655.54
| Facility | | $17,506.59 | $28,655.54 | $28,655.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,421.43 / $27,421.43 / $27,421.43
| Facility | | $27,421.43 | $27,421.43 | $27,421.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,613.00 / $12,240.00 / $27,890.00
| Facility | | $8,613.00 | $12,240.00 | $27,890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,039.20 / $10,967.04 / $25,073.40
| Facility | | $4,039.20 | $10,967.04 | $25,073.40 |