- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,804.00 / $12,853.00 / $20,851.90
| Facility | | $4,804.00 | $12,853.00 | $20,851.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,067.66 / $16,408.58 / $20,671.88
| Facility | | $13,067.66 | $16,408.58 | $20,671.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,877.81 / $13,227.45
| Facility | | $688.00 | $2,877.81 | $13,227.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,897.40 / $12,813.73 / $22,238.92
| Facility | | $7,897.40 | $12,813.73 | $22,238.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,955.59 / $27,753.64 / $27,753.64
| Facility | | $16,955.59 | $27,753.64 | $27,753.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,024.00 / $10,024.00 / $30,198.77
| Facility | | $10,024.00 | $10,024.00 | $30,198.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,091.00 / $11,497.50 / $22,238.92
| Facility | | $8,091.00 | $11,497.50 | $22,238.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $10,301.76 / $23,552.40
| Facility | | $3,800.00 | $10,301.76 | $23,552.40 |